MEDICARE: KERSHAW HOSPITAL LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	HTL-0101	SC

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1245220300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERSHAW HOSPITAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 7003
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29021-7003
Country	:	US
Telephone Number	:	803-432-4311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 ROBERTS ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3737
Country	:	US
Telephone Number	:	803-432-4311
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT VICE PRESIDENT, SECRETARY
Name	:	KATHY J. TEAGUE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	03/12/2021

1315 ROBERTS ST
CAMDEN, SC
29020-3737

Practice Phone: 803-713-6140
Practice Fax:

1315 ROBERTS ST
CAMDEN, SC
29020-3737