Provider Demographics
NPI:1386601094
Name:HUGH G MERRIMAN III MD
Entity type:Organization
Organization Name:HUGH G MERRIMAN III MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MERRIMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-395-4601
Mailing Address - Street 1:1161 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8204
Mailing Address - Country:US
Mailing Address - Phone:803-395-4600
Mailing Address - Fax:803-536-0998
Practice Address - Street 1:1161 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8204
Practice Address - Country:US
Practice Address - Phone:803-395-4601
Practice Address - Fax:803-395-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0593Medicaid
SC432601-001OtherCIGNA
SCD17806Medicare UPIN
SC4208Medicare ID - Type Unspecified
SC920000128Medicare PIN