Provider Demographics
NPI:1780633065
Name:THE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:THE REGIONAL MEDICAL CENTER
Other - Org Name:HOSPICE OF THE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-533-2200
Mailing Address - Street 1:1895 SAINT MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2403
Mailing Address - Country:US
Mailing Address - Phone:803-395-2600
Mailing Address - Fax:803-395-2859
Practice Address - Street 1:1895 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2403
Practice Address - Country:US
Practice Address - Phone:803-395-2600
Practice Address - Fax:803-395-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC037251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP006Medicaid
SCHSP006Medicaid