Healthcare Provider Details

I. General information

NPI: 1972553691
Provider Name (Legal Business Name): MARION REGIONAL HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S MAIN ST
MULLINS SC
29574-3509
US

IV. Provider business mailing address

PO BOX 388
MULLINS SC
29574-0388
US

V. Phone/Fax

Practice location:
  • Phone: 843-464-8244
  • Fax: 843-464-6519
Mailing address:
  • Phone: 843-464-8244
  • Fax: 843-464-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HAROLD E TUCKER
Title or Position: CEO
Credential:
Phone: 843-431-2405