NPIMap

Organization Active NPI

Allendale County Hospital Board

Doing business as Allendale County Hospital Swing Bed

  • Critical Access Hospital
  • Fairfax, SC
National Provider Identifier
1295834992
Registry record updated Aug 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
HTL-041 Issued in SC
Legal business name
ALLENDALE COUNTY HOSPITAL BOARD
Doing business as
Allendale County Hospital Swing Bed
Practice address
1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133
Phone
(803) 632-3311
Fax
(803) 632-3415
NPI assigned
Sep 21, 2006
Last updated
Aug 29, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLENDALE COUNTY HOSPITAL BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 29, 2014

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
Critical Access Hospital 282NC0060X HTL-041 SC Primary

Addresses

Primary practice location

1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133

Mailing address

PO Box 218
Fairfax, SC 29827-0218
Phone (803) 632-3311

Other names 1

  • Allendale County Hospital Swing Bed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220917000629 SC Part A Provider - Critical Access Hospital 2567371610 Practice locations: Fairfax, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295834992. Details of each certification follow.

Hospital certification: CCN 42Z300

Legal name
ALLENDALE COUNTY HOSPITAL BOARD
Doing business as
ALLENDALE COUNTY HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133
Other Hospital Practice Location

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
Part of
Carolina Medical Associ

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 Non-profit Operational/Managerial Control Jan 1, 1996 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
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
Allendale County Hospital BoardFairfax, SC, CCN 423428 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2000

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 21

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.

View all 21

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409270400000",
    "number": "1295834992",
    "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": "1787 ALLENDALE FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298279133",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-3415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLENDALE COUNTY HOSPITAL BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLENDALE COUNTY HOSPITAL BOARD",
        "enumeration_date": "2006-09-21",
        "last_updated": "2014-08-29",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SC",
            "license": "HTL-041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allendale County Hospital Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, SC

Sources for this page

Verify at the official NPI Registry.