MEDICARE: MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0001X	Clinical Cardiac Electrophysiology Physician
2	207RI0011X	Interventional Cardiology Physician
3	363AM0700X	Medical Physician Assistant
4	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1366209918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC

Provider Business Mailing Address
First Line	:	PO BOX 601743
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1743
Country	:	US
Telephone Number	:	843-390-0877
Fax Number	:	843-777-7102

Provider Business Practice Location Address
First Line	:	3793 MCDOWELL LN STE 200
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7892
Country	:	US
Telephone Number	:	843-390-0877
Fax Number	:	843-390-0881

Authorized Official
Title or Position	:	SR VP & CFO
Name	:	SAMUEL FULTON ERVIN III
Credential	:
Telephone Number	:	843-777-2910

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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