NPIMap

Organization Active NPI

Allendale County Hospital Board

Doing business as Laffitte and Warren Medical Center

  • Family Medicine Physician
  • Allendale, SC
National Provider Identifier
1164529491
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HTL-041 Issued in SC
Legal business name
ALLENDALE COUNTY HOSPITAL BOARD
Doing business as
Laffitte and Warren Medical Center
Practice address
623 Memorial Ave N
Allendale, SC 29810-2715
Phone
(803) 632-3311
Fax
(803) 632-3415
NPI assigned
Sep 20, 2006
Last updated
May 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2013

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X HTL-041 SC Primary

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 3

IdentifierTypeStateIssuer
20044797OtherSCSELECT HEALTH
7962704OtherSCAETNA
GP3474MedicaidSC

Other names 1

  • Laffitte and Warren Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Allendale County Hospe7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1164529491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298270218",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 MEMORIAL AVE N",
            "city": "ALLENDALE",
            "state": "SC",
            "postal_code": "298102715",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-3415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLENDALE COUNTY HOSPITAL BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "HIATT",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-632-3311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "HTL-041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT HEALTH",
            "identifier": "20044797",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7962704",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3474",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laffitte and Warren Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Allendale, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.