Provider Demographics
NPI:1811096423
Name:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TOLBERT
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-725-4780
Mailing Address - Street 1:420 THOMSON CIR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5656
Mailing Address - Country:US
Mailing Address - Phone:864-366-5011
Mailing Address - Fax:864-366-3317
Practice Address - Street 1:420 THOMSON CIR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5656
Practice Address - Country:US
Practice Address - Phone:864-366-5011
Practice Address - Fax:864-366-3317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-098275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0098SBMedicaid
SC0098SBMedicaid
SC=========OtherBLUE CROSS BLUE SHIELD SC
SC42Z301Medicare Oscar/Certification