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1003461773 NPI number — MCLEOD HEALTH CLARENDON

NPI Number: 1003461773
Health Care Provider/Practitioner: MCLEOD HEALTH CLARENDON

Information about “1003461773” NPI (MCLEOD HEALTH CLARENDON) exists in 1003461773 in HTML format HTML  |  1003461773 in plain Text format TXT  |  1003461773 in PDF (Portable Document Format) PDF  |  1003461773 in an XML format XML  formats.

NPI Number : 1003461773 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003461773",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MCLEOD HEALTH CLARENDON",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 100567",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FLORENCE",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29502-0567",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "755 E SMITH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TIMMONSVILLE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29161-9430",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-346-3900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/08/2019",
    "LastUpdateDate": "08/14/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ERVIN",
    "AuthorizedOfficialFirstName": "SAMUEL",
    "AuthorizedOfficialMiddleName": "FULTON",
    "AuthorizedOfficialTitle": "SR VICE PRESIDENT AND CFO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": "III",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "843-777-2910",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR1300X",
          "TaxonomyName": "Rural Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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