Provider Demographics
NPI:1972553691
Name:MARION REGIONAL HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:MARION REGIONAL HEALTHCARE SYSTEM
Other - Org Name:ADVANCED MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-431-2405
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-0388
Mailing Address - Country:US
Mailing Address - Phone:843-464-8244
Mailing Address - Fax:843-464-6519
Practice Address - Street 1:511 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3509
Practice Address - Country:US
Practice Address - Phone:843-464-8244
Practice Address - Fax:843-464-6519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION REGIONAL HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
SC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC428956OtherMEDICARE RHC
SC428956OtherOSCAR
SCPA3013Medicaid
SC8178OtherMEDICARE ID TYPE UNSPECIFIED
SC1873Medicare PIN
SC1873Medicare ID - Type UnspecifiedPROVIDER NUMBER