Healthcare Provider Details

I. General information

NPI: 1063813111
Provider Name (Legal Business Name): TRIDENT MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 EMMETT I. DAVIS JR. AVENUE
NORTH CHARLESTON SC
29405
US

IV. Provider business mailing address

5249 EMMETT I. DAVIS JR. AVENUE
NORTH CHARLESTON SC
29405
US

V. Phone/Fax

Practice location:
  • Phone: 843-746-2400
  • Fax: 843-744-9700
Mailing address:
  • Phone: 843-746-2400
  • Fax: 843-744-9700

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: ANDY S. MILLER
Title or Position: CFO
Credential:
Phone: 843-847-4100