Provider Demographics
NPI:1932338787
Name:NEWBERRY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:NEWBERRY COUNTY MEMORIAL HOSPITAL
Other - Org Name:GENERAL SURGICAL SERVICES OF NCMH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-405-7469
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0497
Mailing Address - Country:US
Mailing Address - Phone:803-405-7555
Mailing Address - Fax:
Practice Address - Street 1:1830 POND FIELD ROAD, SUITE A1
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-0497
Practice Address - Country:US
Practice Address - Phone:803-405-7140
Practice Address - Fax:803-405-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5165261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400532Medicaid
SC1118Medicare PIN