Basic Information
| Provider Information | |||||||||
| NPI: | 1700093705 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROBERT S. EAGERTON, JR. M.D.,LLC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 200 E HOSPITAL ST | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291023160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034330439 | ||||||||
| FaxNumber: | 8034339840 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E HOSPITAL ST | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291023160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034330439 | ||||||||
| FaxNumber: | 8034339840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 03/31/2009 | ||||||||
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| AuthorizedOfficialLastName: | EAGERTON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8034330439 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 11415 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | RHC1700093705 | 01 | SC | RHC RIVERBEND | OTHER | RHC1700093705 | 01 | SC | RHC MEDICAID | OTHER | 1700093705 | 05 | SC | MEDICAID |