Basic Information
| Provider Information | |||||||||
| NPI: | 1912937624 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HILTON HEAD HEALTH SYSTEM, L.P. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HILTON HEAD HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 741204 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303741204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782422002 | ||||||||
| FaxNumber: | 8436893670 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HOSPITAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299262738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436816122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | GROTELUSCHEN | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8436898101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | N | Transportation Services | Ambulance | 282N00000X | 646 | SC | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 200299 | 01 | BCBS SOUTH CAROLINA | OTHER | 420080B000000 | 01 | SECTION 1011 | OTHER | 479313 | 01 | AETNA US HEALTHCARE | OTHER | 7206 | 01 | COVENTRY HEALTH CARE GROU | OTHER | 359205480 | 01 | AETNA US HEALTHCARE | OTHER | 388966 | 05 | SC | MEDICAID | 457520 | 05 | SC | MEDICAID | 161888 | 01 | COVENTRY HEALTH CARE GROU | OTHER |