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General NPI Number Information
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NPI Number | 1144875774
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Entity Type | Organization
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Legal Business Name | MCLEOD HEALTH CLARENDON
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 355 S GEORGETOWN HWY
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City | JOHNSONVILLE
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State | SC
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Zip | 29555-8083
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Country | US
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Telephone | 843-380-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100567
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City | FLORENCE
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State | SC
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Zip | 29502-0567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR VICE PRESIDENT AND CFO
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Name | SAMUEL FULTON ERVIN III
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Credential |
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Telephone | 843-777-2910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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