Provider Demographics
NPI:1437238771
Name:CLARENDON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CLARENDON MEMORIAL HOSPITAL
Other - Org Name:EAST CLARENDON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-435-5256
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:TURBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29162
Mailing Address - Country:US
Mailing Address - Phone:803-435-5257
Mailing Address - Fax:803-435-5259
Practice Address - Street 1:944 SMITH STREET
Practice Address - Street 2:
Practice Address - City:TURBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29162
Practice Address - Country:US
Practice Address - Phone:803-435-5257
Practice Address - Fax:803-435-5259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARENDON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC 040Medicaid