Healthcare Provider Details

I. General information

NPI: 1831038314
Provider Name (Legal Business Name): TRIDENT MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N LIVE OAK DR
MONCKS CORNER SC
29461-5603
US

IV. Provider business mailing address

401 N LIVE OAK DR
MONCKS CORNER SC
29461-5603
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-8721
  • Fax:
Mailing address:
  • Phone: 843-761-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFF WILSON
Title or Position: CEO
Credential:
Phone: 843-847-4100