NPIMap

Organization Active NPI

Allendale County Hospital Board

  • Rural Health Clinic/Center
  • Fairfax, SC
National Provider Identifier
1144370503
Registry record updated Sep 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALLENDALE COUNTY HOSPITAL BOARD
Practice address
1787 Allendale Fairfax Highway
Fairfax, SC 29827
Phone
(803) 632-3421
Fax
(803) 632-2410
NPI assigned
Jan 10, 2007
Organization subpart
Yes
Parent organization
ALLENDALE COUNTY HOSPITAL BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Melvin K Hiatt
Title
Administrator
Phone
(803) 632-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X SC Primary

Addresses

Primary practice location

1787 Allendale Fairfax Highway
Fairfax, SC 29827

Mailing address

P.O. Box 218
Fairfax, SC 29827
Phone (803) 632-3421

Other identifiers 1

IdentifierTypeStateIssuer
RHC148MedicaidSC

Other names 1

  • Carolina Medical Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120626000246 SC Part A Provider - Rural Health Clinic 2567371610 Practice locations: Fairfax, SC

Rural health clinic certification: CCN 423428

Legal name
ALLENDALE COUNTY HOSPITAL BOARD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 31, 2005
Last certification
Mar 14, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133
Related CCNs
421300

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Allendale County Hospital7 organizations share this tax ID, including this one
Part of
Allendale County Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Teresa Hicks Individual W-2 Managing EmployeeCfo Feb 1, 2015
Allendale County Hospital Board Organization, Fairfax, SC Operational/Managerial Control Apr 1, 2000 100%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Allendale County HospitalFairfax, SC, CCN 421300 Hospital Operational/Managerial Control (100%) Jan 1, 1996
Allendale County HospitalFairfax, SC, CCN 42Z300 Hospital Operational/Managerial Control (100%) Jan 1, 1996
John Edward Harter Nursing CenterFairfax, SC, CCN 425103 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 1997
Nov 1, 1967

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412035200000",
    "number": "1144370503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 218",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "29827",
            "telephone_number": "803-632-3421",
            "fax_number": "803-632-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 ALLENDALE FAIRFAX HIGHWAY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "29827",
            "telephone_number": "803-632-3421",
            "fax_number": "803-632-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLENDALE COUNTY HOSPITAL BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLENDALE COUNTY HOSPITAL BOARD",
        "enumeration_date": "2007-01-10",
        "last_updated": "2014-09-30",
        "status": "A",
        "authorized_official_last_name": "HIATT",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-632-3311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC148",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, SC

Sources for this page

Verify at the official NPI Registry.