=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730132762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 870 HOLLY ST
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29115-4831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-395-2060
-----------------------------------------------------
Fax | 803-395-0998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1245
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29116-1245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-395-2060
-----------------------------------------------------
Fax | 803-536-0998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LISA GOODLETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-395-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------