Provider Demographics
NPI:1679564702
Name:KERSHAW HOSPITAL LLC
Entity Type:Organization
Organization Name:KERSHAW HOSPITAL LLC
Other - Org Name:KERSHAWHEALTH HEALTHCARE PLACE AT BETHUNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9800
Mailing Address - Street 1:1315 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3737
Mailing Address - Country:US
Mailing Address - Phone:803-432-4311
Mailing Address - Fax:803-713-6384
Practice Address - Street 1:103 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BETHUNE
Practice Address - State:SC
Practice Address - Zip Code:29009
Practice Address - Country:US
Practice Address - Phone:843-334-6557
Practice Address - Fax:843-334-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-101261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC535Medicaid
SCRHC535Medicaid
423420Medicare Oscar/Certification
SCRHC535Medicaid