Provider Demographics
NPI:1942687900
Name:ST MARYS HCA OF SOUTH CAROLINA
Entity type:Organization
Organization Name:ST MARYS HCA OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:RHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-978-4560
Mailing Address - Street 1:2603 CUMBERLAND GAP DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-978-4560
Mailing Address - Fax:
Practice Address - Street 1:2603 CUMBERLAND GAP DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-978-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center