Provider Demographics
NPI:1538707146
Name:MCLEOD HEALTH CHERAW
Entity Type:Organization
Organization Name:MCLEOD HEALTH CHERAW
Other - Org Name:MCLEOD PRIMARY CARE AND PEDIATRICS BENNETTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
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 1:555 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2617
Mailing Address - Country:US
Mailing Address - Phone:843-777-5562
Mailing Address - Fax:
Practice Address - Street 1:1076 MARLBORO WAY STE 3
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2495
Practice Address - Country:US
Practice Address - Phone:843-479-0432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-13
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty