Provider Demographics
NPI:1790876902
Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Entity Type:Organization
Organization Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Other - Org Name:MCLEOD AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUYERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-777-4401
Mailing Address - Street 1:604 EAST CHEVES STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-669-3822
Mailing Address - Fax:843-669-6116
Practice Address - Street 1:604 EAST CHEVES STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-669-3822
Practice Address - Fax:843-669-6116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410022Medicaid
SC=========-059OtherBCBS
SC410022Medicaid