Healthcare Provider Details

I. General information

NPI: 1417182783
Provider Name (Legal Business Name): NEWBERRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N MILL ST
LITTLE MOUNTAIN SC
29075-8788
US

IV. Provider business mailing address

99 N MILL ST
LITTLE MOUNTAIN SC
29075-8788
US

V. Phone/Fax

Practice location:
  • Phone: 803-945-1005
  • Fax:
Mailing address:
  • Phone: 803-945-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MICHAEL L REYNOLDS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 803-405-7469