Provider Demographics
NPI:1588737498
Name:KERSHAW HOSPITAL LLC
Entity type:Organization
Organization Name:KERSHAW HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIECHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9800
Mailing Address - Street 1:PO BOX 7003
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-7003
Mailing Address - Country:US
Mailing Address - Phone:803-713-6376
Mailing Address - Fax:
Practice Address - Street 1:1315 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3737
Practice Address - Country:US
Practice Address - Phone:803-713-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIC0031Medicaid
SC42D0248614OtherCLIA#
SCIC0031Medicaid
420048Medicare Oscar/Certification