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	:	1427997907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIDENT MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	945 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3919
Country	:	US
Telephone Number	:	854-214-2510
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3919
Country	:	US
Telephone Number	:	854-214-2510
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFF WILSON
Credential	:
Telephone Number	:	843-847-4100

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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