Provider Demographics
NPI:1043289333
Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Entity type:Organization
Organization Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-777-2910
Mailing Address - Street 1:1203 EAST CHEVES STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2711
Mailing Address - Country:US
Mailing Address - Phone:843-777-2564
Mailing Address - Fax:843-777-5135
Practice Address - Street 1:1203 EAST CHEVES STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2711
Practice Address - Country:US
Practice Address - Phone:843-777-2564
Practice Address - Fax:843-777-5135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-17
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPF003251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP009Medicaid
SC=========003OtherBCBS PROVIDER NUMBER
SC=========002OtherBCBS PROVIDER NUMBER
SC=========002OtherBCBS PROVIDER NUMBER