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General NPI Number Information
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NPI Number | 1639475429
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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 | 02/26/2020
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Provider Practice Location Address
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Address Line | 1619 CAROLINA AVE
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City | ORANGEBURG
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State | SC
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Zip | 29115-4939
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Country | US
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Telephone | 803-531-7474
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Fax | 803-531-7457
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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 | 803-536-0998
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Authorized Official
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Title or Position | C F O
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Name | LIZA M PORTERFIELD
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Credential |
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Telephone | 803-395-4458
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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 | SC
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