Provider Demographics
NPI:1194197509
Name:STEELE CREEK EMERGENCY ROOM/ EMP
Entity Type:Organization
Organization Name:STEELE CREEK EMERGENCY ROOM/ EMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-451-4034
Mailing Address - Street 1:1908 PACES LANDING AVE
Mailing Address - Street 2:APT 1838
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2484
Mailing Address - Country:US
Mailing Address - Phone:203-592-8489
Mailing Address - Fax:
Practice Address - Street 1:1908 PACES LANDING AVE
Practice Address - Street 2:APT 1838
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2484
Practice Address - Country:US
Practice Address - Phone:203-592-8489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04329282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital