Provider Demographics
NPI:1073314852
Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Entity type:Organization
Organization Name:MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-777-2010
Mailing Address - Street 1:101 WILLIAM H JOHNSON ST STE 200-B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2763
Mailing Address - Country:US
Mailing Address - Phone:843-777-5735
Mailing Address - Fax:843-777-2804
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 200-B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2763
Practice Address - Country:US
Practice Address - Phone:843-777-5735
Practice Address - Fax:843-777-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty