Healthcare Provider Details

I. General information

NPI: 1467550087
Provider Name (Legal Business Name): EDISTO REGIONAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 JOHN LAWSON AVE
SANTEE SC
29142-8654
US

IV. Provider business mailing address

PO BOX 1245
ORANGEBURG SC
29116-1245
US

V. Phone/Fax

Practice location:
  • Phone: 803-395-2070
  • Fax: 803-395-2097
Mailing address:
  • Phone: 803-395-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTAL LEANN FULMER
Title or Position: MANAGER
Credential:
Phone: 803-395-4248