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General NPI Number Information
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NPI Number | 1538707146
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Entity Type | Organization
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Legal Business Name | MCLEOD HEALTH CHERAW
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1076 MARLBORO WAY STE 3
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-2495
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Country | US
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Telephone | 843-479-0432
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Fax |
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Provider Business Mailing Address
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Address Line | 555 E CHEVES ST
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City | FLORENCE
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State | SC
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Zip | 29506-2617
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Country | US
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Telephone | 843-777-5562
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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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Taxonomy #2
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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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