Healthcare Provider Details

I. General information

NPI: 1134317688
Provider Name (Legal Business Name): EDISTO REGIONAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 SAINT MATTHEWS RD
ORANGEBURG SC
29118-2042
US

IV. Provider business mailing address

PO BOX 1245
ORANGEBURG SC
29116-1245
US

V. Phone/Fax

Practice location:
  • Phone: 803-534-5252
  • Fax: 803-531-0676
Mailing address:
  • Phone: 803-395-4499
  • Fax: 803-395-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS O DANDRIDGE
Title or Position: PRESIDENT
Credential:
Phone: 803-395-2200