Provider Demographics
NPI:1245594571
Name:SC REGIONAL HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:SC REGIONAL HEALTH SYSTEM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:ATTN: CLINIC BUSINESS OFFICE
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1573
Mailing Address - Country:US
Mailing Address - Phone:803-266-3600
Mailing Address - Fax:803-266-3641
Practice Address - Street 1:45 ROUNDTREE ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-2303
Practice Address - Country:US
Practice Address - Phone:803-266-3600
Practice Address - Fax:803-266-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty