Provider Demographics
NPI:1750353827
Name:CLARENDON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CLARENDON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-435-3235
Mailing Address - Street 1:37 W RIGBY ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3236
Mailing Address - Country:US
Mailing Address - Phone:803-435-9927
Mailing Address - Fax:803-435-9748
Practice Address - Street 1:37 W RIGBY ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3236
Practice Address - Country:US
Practice Address - Phone:803-435-9927
Practice Address - Fax:803-435-9748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARENDON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-03
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1097Medicaid
SCDE1097Medicaid