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Allendale County Hospital Board

Organization Active NPI Critical Access Hospital · Fairfax, SC

NPI 1295834992 · NPPES record last updated Aug 29, 2014

Key facts

NPI
1295834992
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
HTL-041 (SC)
Legal business name
ALLENDALE COUNTY HOSPITAL BOARD
Practice address
1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133
Phone
(803) 632-3311
Fax
(803) 632-3415
NPI assigned
Sep 21, 2006
Organization subpart
Yes
Parent organization (as reported)
ALLENDALE COUNTY HOSPITAL BOARD

Authorized official

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

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in SC

Hospital certification: CCN 42Z300

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

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 Employee
Cfo		 Feb 1, 2015
Allendale County Hospital Board
Organization · Fairfax, SC
Non-profit 		Operational/Managerial Control Jan 1, 1996 100%

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 Hospital
Fairfax, SC · CCN 421300		 Hospital Operational/Managerial Control (100%) Jan 1, 1996
John Edward Harter Nursing Center
Fairfax, 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 Board
Fairfax, SC · CCN 423428		 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2000

Medicare enrollment records

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

National Provider Directory

Part of
Allendale County Hospital

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X HTL-041 SC Yes

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 identifiers

IdentifierTypeStateIssuer
0041SBMedicaidSC

Other names

  • Allendale County Hospital Swing Bed Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 29, 2014.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0041SB",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allendale County Hospital Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, SC

All providers in Fairfax, SC · Critical Access Hospital in South Carolina

Sources for this page

Verify at the official NPI Registry.