Healthcare Provider Details

I. General information

NPI: 1588678627
Provider Name (Legal Business Name): MARION REGIONAL HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S MAIN ST
MULLINS SC
29574-3510
US

IV. Provider business mailing address

518 S MAIN ST
MULLINS SC
29574-3510
US

V. Phone/Fax

Practice location:
  • Phone: 843-464-8211
  • Fax: 843-464-1330
Mailing address:
  • Phone: 843-464-8211
  • Fax: 843-464-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number828
License Number StateSC

VII. Legacy identifiers

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

# 1
Identifier0562NH
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: HAROLD E TUCKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 843-431-2405