Healthcare Provider Details

I. General information

NPI: 1962213785
Provider Name (Legal Business Name): NEWBERRY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 KINARD ST STE 208
NEWBERRY SC
29108-2966
US

IV. Provider business mailing address

2605 KINARD ST STE 208
NEWBERRY SC
29108-2966
US

V. Phone/Fax

Practice location:
  • Phone: 803-945-4202
  • Fax: 803-945-4238
Mailing address:
  • Phone: 803-945-4202
  • Fax: 803-945-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN WALTER PUGH
Title or Position: BOARD MEMBER
Credential:
Phone: 803-364-2310