Allendale County Hospital Board
Organization Active NPI Family Medicine Physician · Allendale, SC
NPI 1164529491 · NPPES record last updated May 14, 2013
Key facts
- NPI
- 1164529491
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- HTL-041 (SC)
- Legal business name
- ALLENDALE COUNTY HOSPITAL BOARD
- Practice address
- 623 Memorial Ave N
Allendale, SC 29810-2715 - Phone
- (803) 632-3311
- Fax
- (803) 632-3415
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Ken Hiatt
- Title
- Administrator
- Phone
- (803) 632-3311
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 6
Practitioners 2
-
Nancy Taylor Young, DNP, APRN, FNP-C
-
Gerardo Baldassarri, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040304000896 | SC | Part B Supplier - Clinic/Group Practice | 2567371610 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Allendale, SC; Fairfax, SC |
National Provider Directory
- Tax ID family
- Allendale County Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | HTL-041 | SC | Yes |
Addresses
Primary practice location
623 Memorial Ave N
Allendale, SC 29810-2715
Mailing address
PO Box 218
Fairfax, SC 29827-0218
Phone (803) 632-3311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20044797 | Other | SC | SELECT HEALTH |
| 7962704 | Other | SC | AETNA |
| GP3474 | Medicaid | SC |
Other names
- Laffitte and Warren Medical Center
Other providers in Allendale, SC
- Allendale County Hospital Board
- Allendale County Rescue Squad Inc
- Az Medical Transport
- Ianthe Bing
- Carolina Country Care in-Home LLC
All providers in Allendale, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.