Provider Demographics
NPI:1336388735
Name:UNION HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:UNION HOSPITAL DISTRICT
Other - Org Name:CHA- UNION INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-427-2401
Mailing Address - Street 1:408 N DUNCAN BY PASS
Mailing Address - Street 2:SUITE L
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379
Mailing Address - Country:US
Mailing Address - Phone:864-427-2401
Mailing Address - Fax:864-427-7119
Practice Address - Street 1:408 N DUNCAN BY PASS
Practice Address - Street 2:SUITE L
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379
Practice Address - Country:US
Practice Address - Phone:864-427-2401
Practice Address - Fax:864-427-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5094Medicaid
SCGP5094Medicaid