Provider Demographics
NPI:1447291695
Name:CLARENDON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CLARENDON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-435-3235
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:944 SMITH ST
Mailing Address - City:TURBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29162-0206
Mailing Address - Country:US
Mailing Address - Phone:843-659-2114
Mailing Address - Fax:843-659-2161
Practice Address - Street 1:944 SMITH STREET
Practice Address - Street 2:
Practice Address - City:TURBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29162-0206
Practice Address - Country:US
Practice Address - Phone:843-659-2114
Practice Address - Fax:843-659-2161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARENDON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC423983Medicare Oscar/Certification
SC420069Medicare Oscar/Certification
SC7602Medicare PIN
SC7602Medicare PIN