Organization
MCLEOD HEALTH CLARENDON
Active
Parent organization
MCLEOD HEALTH
Other names
Eagerton Family Medicine, McLeod Family Medicine-Dr. Eagerton, Jr.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCLEOD HEALTH
Authorized official
MR. SAMUEL FULTON ERVIN III (SR VICE PRESIDENT AND CFO)
(843) 777-2910
Entity
Organization
Contact information
Practice address
200 E HOSPITAL ST, MANNING, SC 29102-3160
(803) 433-0439
Mailing address
200 E HOSPITAL ST, MANNING, SC 29102-3160
(803) 433-0439
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-3801
MEDICARE
SC
05
—
RHC242
—
SC
Enumeration date
06/09/2016
Last updated
04/17/2020
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