Healthcare Provider Details

I. General information

NPI: 1639117732
Provider Name (Legal Business Name): EDISTO REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 VILLAGE PARK DR
ORANGEBURG SC
29118-2475
US

IV. Provider business mailing address

PO BOX 1442
ORANGEBURG SC
29116-1442
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-2722
  • Fax:
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 DANDRIDGE
Title or Position: PRESIDENT
Credential:
Phone: 803-395-2200