Provider Demographics
NPI:1285618132
Name:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-366-3279
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0887
Mailing Address - Country:US
Mailing Address - Phone:864-366-3279
Mailing Address - Fax:864-366-3317
Practice Address - Street 1:901 W GREENWOOD ST STE 1
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5717
Practice Address - Country:US
Practice Address - Phone:864-366-9681
Practice Address - Fax:864-366-5600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBEVILLE COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC3126Medicaid
SC2811Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
SC3255Medicare PIN