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General NPI Number Information
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NPI Number | 1497104525
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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 | 06/09/2016
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 22 BOZARD ST
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City | MANNING
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State | SC
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Zip | 29102-2935
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Country | US
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Telephone | 803-435-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BOZARD ST
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City | MANNING
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State | SC
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Zip | 29102-2935
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Country | US
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Telephone | 803-435-8828
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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 | MR. 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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