TRIDENT MEDICAL CENTER LLC

Provider Demographics

• NPI: 1366496937
• Name: TRIDENT MEDICAL CENTER LLC
• Entity type: Organization
• Organization Name: TRIDENT MEDICAL CENTER LLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: KEVIN
• Authorized Official - Last Name: MCKEOWN
• Authorized Official - Phone: 843-847-4254
• Mailing Address - Street 1: 9330 MEDICAL PLAZA DR
• Mailing Address - City: CHARLESTON
• Mailing Address - State: SC
• Mailing Address - Zip Code: 29406-9104
• Mailing Address - Country: US
• Mailing Address - Phone: 843-847-7000
• Mailing Address - Fax: 843-847-4086
• Practice Address - Street 1: 9330 MEDICAL PLAZA DR
• Practice Address - City: CHARLESTON
• Practice Address - State: SC
• Practice Address - Zip Code: 29406-9104
• Practice Address - Country: US
• Practice Address - Phone: 843-847-7000
• Practice Address - Fax: 843-847-4086
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-19
• Last Update Date: 2025-06-04

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MS	00096542	Medicaid
MO	016119109	Medicaid
	166376800	Other	DEPT OF LABOR
IN	200241300A	Medicaid
	420079	Other	HIGHMARK BLUE CROSS
NJ	4212304	Medicaid
	272545	Other	BLACK LUNG
WI	81237100	Medicaid
GA	00881944X	Medicaid
DC	032516900	Medicaid
PA	30696	Medicaid
	6699	Other	BLUE CARE
MA	1004107	Medicaid
	10043717	Other	GATEWAY MEDICAID
MI	304744932	Medicaid
OH	733728	Medicaid
NY	978634	Medicaid
KY	01601129	Medicaid
NV	100506046	Medicaid
LA	1745936	Medicaid
KS	200357120A	Medicaid
FL	909075400	Medicaid
AL	TRI0079N	Medicaid
CA	XHSP33273	Medicaid
DE	1000037000	Medicaid
AR	158181105	Medicaid
WA	3025186	Medicaid
RI	4200790	Medicaid
NE	10025100800	Medicaid
OK	100698030A	Medicaid
	5000221	Other	PHYSICIANS HEALTH PLAN
	1537918	Other	UNITED MINE WORKERS
SC	269338	Medicaid
VA	4200799	Medicaid
AZ	873192	Medicaid
WI	81237100	Medicaid
NY	978634	Medicaid