Provider Demographics
NPI:1598746141
Name:MCLEOD MEDICAL CENTER-DILLON
Entity Type:Organization
Organization Name:MCLEOD MEDICAL CENTER-DILLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
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:PO BOX 100567
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0567
Mailing Address - Country:US
Mailing Address - Phone:843-777-4402
Mailing Address - Fax:843-777-5249
Practice Address - Street 1:301 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2509
Practice Address - Country:US
Practice Address - Phone:843-777-4402
Practice Address - Fax:843-777-5249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-854282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB00091Medicaid
NC4200005Medicaid
SCA00091Medicaid
NC4200005Medicaid