MEDICARE: RSF MT PLEASANT HOSPITAL

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	291U00000X	Clinical Medical Laboratory	42D2013764	SC

General Provider Information

NPI Number	:	1205280658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RSF MT PLEASANT HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 602441
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2441
Country	:	US
Telephone Number	:	843-606-7565
Fax Number	:	843-606-7912

Provider Business Practice Location Address
First Line	:	3500 N HIGHWAY 17
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9123
Country	:	US
Telephone Number	:	843-606-7565
Fax Number	:	843-606-7912

Authorized Official
Title or Position	:	CEO
Name	:	ANTHONY JACKSON
Credential	:
Telephone Number	:	843-606-1000

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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Directions to “RSF MT PLEASANT HOSPITAL ” Practice Location

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