Provider Demographics
NPI:1134170764
Name:MEDICAL CENTER INC. OF PICKENS
Entity type:Organization
Organization Name:MEDICAL CENTER INC. OF PICKENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:864-855-2323
Mailing Address - Street 1:838 POWDERSVILLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3703
Mailing Address - Country:US
Mailing Address - Phone:864-855-2323
Mailing Address - Fax:864-855-2606
Practice Address - Street 1:838 POWDERSVILLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3703
Practice Address - Country:US
Practice Address - Phone:864-855-2323
Practice Address - Fax:864-855-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC608612Medicaid
SC708614Medicaid
SC708614Medicaid