MEDICARE: HUGH G MERRIMAN III MD

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	261QX0203X	Radiation Oncology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	432601-001	OTHER	SC	CIGNA

General Provider Information

NPI Number	:	1386601094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGH G MERRIMAN III MD

Provider Business Mailing Address
First Line	:	1161 COOK RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8204
Country	:	US
Telephone Number	:	803-395-4600
Fax Number	:	803-536-0998

Provider Business Practice Location Address
First Line	:	1161 COOK RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8204
Country	:	US
Telephone Number	:	803-395-4601
Fax Number	:	803-395-4620

Authorized Official
Title or Position	:	OWNER
Name	:	HUGH G MERRIMAN III
Credential	:	MD
Telephone Number	:	803-395-4601

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	04/22/2008

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