Provider Demographics
NPI:1891054193
Name:SC REGIONAL HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:SC REGIONAL HEALTH SYSTEM LLC
Other - Org Name:SOUTHERN CAROLINA REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:VALLIANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-541-4365
Mailing Address - Street 1:811 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1573
Mailing Address - Country:US
Mailing Address - Phone:803-259-1000
Mailing Address - Fax:
Practice Address - Street 1:811 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1573
Practice Address - Country:US
Practice Address - Phone:803-259-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL0485282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
420016Medicare Oscar/Certification