Provider Demographics
NPI:1164639423
Name:MARION REGIONAL HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:MARION REGIONAL HEALTHCARE SYSTEM
Other - Org Name:MULLINS SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-431-2405
Mailing Address - Street 1:119 W LOWMAN ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3107
Mailing Address - Country:US
Mailing Address - Phone:843-464-4000
Mailing Address - Fax:843-464-4017
Practice Address - Street 1:119 W LOWMAN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3107
Practice Address - Country:US
Practice Address - Phone:843-464-4000
Practice Address - Fax:843-464-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4694Medicaid
SC079293Medicaid
SC8178Medicare PIN
SCGP4694Medicaid