Healthcare Provider Details

I. General information

NPI: 1528316585
Provider Name (Legal Business Name): CLARENDON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E HOSPITAL ST SUITE 100
MANNING SC
29102-3153
US

IV. Provider business mailing address

10 E HOSPITAL ST SUITE 100
MANNING SC
29102-3153
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-5212
  • Fax: 803-435-3389
Mailing address:
  • Phone: 803-435-5212
  • Fax: 803-435-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD STOKES
Title or Position: CEO
Credential:
Phone: 803-435-8465