Provider Demographics
NPI:1073594313
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:MCLEOD TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
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:PO BOX 100567
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0567
Mailing Address - Country:US
Mailing Address - Phone:843-777-4402
Mailing Address - Fax:843-777-5249
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-777-4402
Practice Address - Fax:843-777-5249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-11
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAMB008Medicaid
NC3406854Medicaid
SC=========010OtherBCBS SC
SC420051Medicare Oscar/Certification