Provider Demographics
NPI:1255367637
Name:OCONEE MEDICAL CENTER
Entity type:Organization
Organization Name:OCONEE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-885-7600
Mailing Address - Street 1:PO BOX 751710
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:298 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9443
Practice Address - Country:US
Practice Address - Phone:864-882-3351
Practice Address - Fax:864-885-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
SCHTL062282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400097Medicaid
SC500345Medicaid
SCDPE039Medicaid
SCGP1228Medicaid
SC247902Medicaid
SC354027Medicaid
SCIC0030Medicaid
SCDE1237Medicaid
SCGP2452Medicaid
SC247902Medicaid
SCGP2452Medicaid
SCDPE039Medicaid
SCIC0030Medicaid
SC=========003OtherCRNA
SC420009Medicare Oscar/Certification