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Organization

MARION REGIONAL HEALTHCARE SYSTEM

Active
Other names
Carolina Pediatrics
Organization subpart
No

Provider details

NPI number
Authorized official
HAROLD E TUCKER (CHIEF EXECUTIVE OFFICER)
(843) 431-2405
Entity
Organization

Contact information

Practice address
2845 E HIGHWAY 76, SUITE 5A, MULLINS, SC 29574-6037
(843) 431-2710
(843) 431-2716
Mailing address
PO BOX 1150, MARION, SC 29571-1150
(843) 431-2710
(843) 431-2716

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
288183
SC
05
GP4562
SC
Enumeration date
07/28/2006
Last updated
11/08/2007
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