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General NPI Number Information
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NPI Number | 1275839078
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Entity Type | Organization
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Legal Business Name | EDISTO REGIONAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 5073 CAROLINA HWY
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City | DENMARK
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State | SC
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Zip | 29042-1679
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Country | US
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Telephone | 803-793-3034
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Fax | 803-245-6277
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Provider Business Mailing Address
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Address Line | PO BOX 1245
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City | ORANGEBURG
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State | SC
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Zip | 29116-1245
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Country | US
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Telephone | 803-395-4762
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Fax | 803-395-2237
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Authorized Official
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Title or Position | C F O
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Name | CHERYL S MASON
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Credential |
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Telephone | 803-395-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | SC
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Taxonomy #2
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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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