Provider Demographics
NPI:1265481550
Name:CLARENDON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CLARENDON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:803-435-8463
Mailing Address - Street 1:10 HOSPITAL STREET
Mailing Address - Street 2:P.O. BOX 550
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102
Mailing Address - Country:US
Mailing Address - Phone:803-435-8463
Mailing Address - Fax:
Practice Address - Street 1:10 HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-435-8463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL 012282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC353364Medicaid
SC600020OtherSELECT HEALTH
SC117267OtherUNISON
SC431354Medicaid
SC431354Medicaid