Provider Demographics
NPI:1063449361
Name:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Other - Org Name:ABBEVILLE AREA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-366-3279
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0887
Mailing Address - Country:US
Mailing Address - Phone:864-336-3279
Mailing Address - Fax:864-366-3317
Practice Address - Street 1:420 THOMSON CIR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620
Practice Address - Country:US
Practice Address - Phone:864-366-5011
Practice Address - Fax:864-366-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-098282NC0060X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPE053Medicaid
FL9089888 00Medicaid
SC0098SBMedicaid
SC142571Medicaid
SC252726Medicaid
SC400612Medicaid
GA00104607AMedicaid
SC400612Medicaid
SC0098SBMedicaid
SC142571Medicaid
SCCC5830Medicare PIN
FL9089888 00Medicaid