Provider Demographics
NPI:1649561549
Name:REGENCY HOSPITAL COMPANY OF SOUTH CAROLINA, L.L.C.
Entity Type:Organization
Organization Name:REGENCY HOSPITAL COMPANY OF SOUTH CAROLINA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:4714 GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:717-975-9981
Practice Address - Street 1:121 E CEDAR ST
Practice Address - Street 2:4TH AND 5TH FLOOR
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2576
Practice Address - Country:US
Practice Address - Phone:717-972-1100
Practice Address - Fax:717-975-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11067AMedicaid