Organization
MCLEOD HEALTH CLARENDON
Active
Parent organization
MCLEOD HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCLEOD HEALTH
Authorized official
SAMUEL F ERVIN III (SR VICE PRESIDENT AND CFO)
(843) 777-2910
Entity
Organization
Contact information
Practice address
10 E HOSPITAL ST, MANNING, SC 29102-3153
(843) 435-8463
Mailing address
10 E HOSPITAL ST, MANNING, SC 29102-3153
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G064
MEDICARE
SC
05
—
GP7479
—
SC
Enumeration date
07/12/2016
Last updated
02/25/2019
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