MEDICARE: TRIDENT MEDICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1063813111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIDENT MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	5249 EMMETT I. DAVIS JR. AVENUE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405
Country	:	US
Telephone Number	:	843-746-2400
Fax Number	:	843-744-9700

Provider Business Practice Location Address
First Line	:	5249 EMMETT I. DAVIS JR. AVENUE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405
Country	:	US
Telephone Number	:	843-746-2400
Fax Number	:	843-744-9700

Authorized Official
Title or Position	:	CFO
Name	:	ANDY S. MILLER
Credential	:
Telephone Number	:	843-847-4100

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	10/01/2025

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