Provider Demographics
NPI:1912137407
Name:BARNWELL COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BARNWELL COUNTY HOSPITAL
Other - Org Name:WAGENER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:H
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-541-4173
Mailing Address - Street 1:120 LOUIE STREET
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164
Mailing Address - Country:US
Mailing Address - Phone:803-284-0020
Mailing Address - Fax:803-284-5516
Practice Address - Street 1:120 LOUIE STREET
Practice Address - Street 2:
Practice Address - City:WAGENER
Practice Address - State:SC
Practice Address - Zip Code:29164
Practice Address - Country:US
Practice Address - Phone:803-284-0020
Practice Address - Fax:803-284-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42-3439Medicare PIN