Healthcare Provider Details

I. General information

NPI: 1982650107
Provider Name (Legal Business Name): EDISTO REGIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 PELHAM CT
ORANGEBURG SC
29118-1400
US

IV. Provider business mailing address

PO BOX 1245
ORANGEBURG SC
29116-1245
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-8500
  • Fax:
Mailing address:
  • Phone: 803-395-4499
  • Fax: 803-536-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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