Basic Information
| Provider Information | |||||||||
| NPI: | 1447291695 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLARENDON MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EAST CLARENDON MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 206 | ||||||||
| Address2: | 944 SMITH ST | ||||||||
| City: | TURBEVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291620206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436592114 | ||||||||
| FaxNumber: | 8436592161 | ||||||||
| Practice Location | |||||||||
| Address1: | 944 SMITH STREET | ||||||||
| Address2: | |||||||||
| City: | TURBEVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291620206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436592114 | ||||||||
| FaxNumber: | 8436592161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | STOKES | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8034353235 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLARENDON MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.