Provider Demographics
NPI:1508094913
Name:KERSHAW HOSPITAL LLC
Entity Type:Organization
Organization Name:KERSHAW HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:40 PINNACLE PARKWAY
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045
Mailing Address - Country:US
Mailing Address - Phone:803-424-5160
Mailing Address - Fax:
Practice Address - Street 1:40 PINNACLE PARKWAY
Practice Address - Street 2:BUILDING 100
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045
Practice Address - Country:US
Practice Address - Phone:803-432-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7138Medicaid
SCGP5297Medicaid
CA8394Medicare PIN
SCF245Medicare PIN
SC9386Medicare PIN
SC420048Medicaid
3410Medicare PIN