Healthcare Provider Details

I. General information

NPI: 1871350421
Provider Name (Legal Business Name): MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MCLEOD HEALTH BLVD STE 201
MYRTLE BEACH SC
29579-4477
US

IV. Provider business mailing address

PO BOX 601743
CHARLOTTE NC
28260-1743
US

V. Phone/Fax

Practice location:
  • Phone: 843-646-8001
  • Fax: 843-646-8002
Mailing address:
  • Phone: 843-646-8001
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL FULTON ERVIN III
Title or Position: SR VP & CFO
Credential:
Phone: 843-777-2000