NPIMap

Organization Active NPI

Clarendon Memorial Hospital

Doing business as Clarendon Pediatric Associates

  • Pediatrics Physician
  • Manning, SC
National Provider Identifier
1225435134
Registry record updated Mar 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CLARENDON MEMORIAL HOSPITAL
Doing business as
Clarendon Pediatric Associates
Practice address
50 E Hospital St
Ste 4B
Manning, SC 29102-3149
Phone
(803) 433-8419
Fax
(803) 433-8417
NPI assigned
Nov 21, 2014
Last updated
Mar 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2016

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

Authorized official

Name
John Shaughnessy
Title
Cfo
Phone
(803) 435-3239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

50 E Hospital St
Ste 4B
Manning, SC 29102-3149

Mailing address

PO Box 550
Attn: Credentialing
Manning, SC 29102-3153
Phone (803) 435-5248

Other identifiers 1

IdentifierTypeStateIssuer
GP6760MedicaidSC

Other names 1

  • Clarendon Pediatric 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": "1416528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1225435134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153",
            "telephone_number": "803-435-5248",
            "fax_number": "803-435-5288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E HOSPITAL ST",
            "address_2": "STE 4B",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-433-8419",
            "fax_number": "803-433-8417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARENDON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-21",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "SHAUGHNESSY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "803-435-3239"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6760",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarendon Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manning, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.