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	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1669367470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC

Provider Business Mailing Address
First Line	:	555 E CHEVES ST
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2617
Country	:	US
Telephone Number	:	843-777-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3781 MCDOWELL LANE
Second Line	:	STE 110
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-8930
Country	:	US
Telephone Number	:	843-366-2012
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VP AND CFO
Name	:	SAMUEL FULTON ERVIN III
Credential	:
Telephone Number	:	843-777-2000

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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