Provider Demographics
NPI:1891960852
Name:SCOTLAND MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTLAND MEMORIAL HOSPITAL
Other - Org Name:MARLBORO OB GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-291-7547
Mailing Address - Street 1:PO BOX 604093
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4093
Mailing Address - Country:US
Mailing Address - Phone:910-291-7000
Mailing Address - Fax:
Practice Address - Street 1:1007 CHERAW HIGHWAY
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:243-479-8357
Practice Address - Fax:843-479-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36237207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4887Medicaid
SC6838Medicare PIN