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General NPI Number Information
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NPI Number | 1700093705
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Entity Type | Organization
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Legal Business Name | ROBERT S. EAGERTON, JR. M.D.,LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 200 E HOSPITAL ST
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City | MANNING
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State | SC
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Zip | 29102-3160
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Country | US
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Telephone | 803-433-0439
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Fax | 803-433-9840
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Provider Business Mailing Address
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Address Line | 200 E HOSPITAL ST
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City | MANNING
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State | SC
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Zip | 29102-3160
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Country | US
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Telephone | 803-433-0439
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Fax | 803-433-9840
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT S EAGERTON JR.
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Credential | M.D.
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Telephone | 803-433-0439
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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 | 11415
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License Number State | SC
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