Provider Demographics
NPI:1336173970
Name:MARION REGIONAL HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:MARION REGIONAL HEALTHCARE SYSTEM
Other - Org Name:PEE DEE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
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 1150
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1150
Mailing Address - Country:US
Mailing Address - Phone:843-431-2650
Mailing Address - Fax:843-431-2647
Practice Address - Street 1:2835 E HIGHWAY 76
Practice Address - Street 2:SUITE 7
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6038
Practice Address - Country:US
Practice Address - Phone:843-431-2650
Practice Address - Fax:843-431-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
SCRHC 121261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC121Medicaid
SC428928Medicare ID - Type Unspecified