NPIMap

Organization Active NPI

Marion Regional Healthcare System

  • Surgery Physician
  • Mullins, SC
National Provider Identifier
1164639423
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MARION REGIONAL HEALTHCARE SYSTEM
Practice address
119 W Lowman St
Mullins, SC 29574-3107
Phone
(843) 464-4000
Fax
(843) 464-4017
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Authorized official

Name
Harold E Tucker
Title
Ceo
Phone
(843) 431-2405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

119 W Lowman St
Mullins, SC 29574-3107

Mailing address

119 W Lowman St
Mullins, SC 29574-3107
Phone (843) 464-4000

Other identifiers 2

IdentifierTypeStateIssuer
GP4694MedicaidSC
079293MedicaidSC

Other names 1

  • Mullins Surgical Associates Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1164639423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W LOWMAN ST",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295743107",
            "telephone_number": "843-464-4000",
            "fax_number": "843-464-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W LOWMAN ST",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295743107",
            "telephone_number": "843-464-4000",
            "fax_number": "843-464-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARION REGIONAL HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-431-2405"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4694",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079293",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mullins Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mullins, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.