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NPI Code Detail

MEDICARE: DR. ROBERT S EAGERTON JR. M.D.

MEDICARE: DR. ROBERT S EAGERTON JR. M.D.
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
1207Q00000XFamily Medicine Physician11415SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4010012018OTHERSCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11558366039OTHERSCRHC RIVERBEND
21821380197OTHERSCGROUP NPI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558366039
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT S EAGERTON JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 3239
Second Line :
City : FLORENCE
State : SC
Zip : 29502-3239
Country : US
Telephone Number : 803-435-5270
Fax Number : 803-433-0154
Provider Business Practice Location Address
First Line : 200 E HOSPITAL ST
Second Line :
City : MANNING
State : SC
Zip : 29102-3160
Country : US
Telephone Number : 803-433-0439
Fax Number : 803-433-9840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 02/02/2021

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1336413681 — CLARENDON MEMORIAL HOSPITAL
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1962851097 — MCLEOD HEALTH CLARENDON
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1659722411 — DR. CARMEN CRIBB ROBERTS D.O.
Practice Location Address:
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Practice Fax: 803-433-9840

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