Healthcare Provider Details

I. General information

NPI: 1265481550
Provider Name (Legal Business Name): CLARENDON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL STREET
MANNING SC
29102
US

IV. Provider business mailing address

10 HOSPITAL STREET P.O. BOX 550
MANNING SC
29102
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-8463
  • Fax:
Mailing address:
  • Phone: 803-435-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberHTL 012
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier353364
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier600020
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerSELECT HEALTH
# 3
Identifier117267
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerUNISON
# 4
Identifier431354
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: RICHARD W STOKES JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 803-435-8463