Edgefield County Hospital

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

HTL479 Issued in SC

Legal business name

EDGEFIELD COUNTY HOSPITAL

Doing business as

Peach Tree Medical Center

Practice address

155 Ridge Medical Plaza
Suite B
Egefield, SC 29824-4535

Phone

(803) 637-3630

Fax

(803) 637-5348

NPI assigned

Jul 3, 2008

Last updated

Jan 22, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

EDGEFIELD COUNTY HOSPITALAs reported in NPPES

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

Authorized official

Name

Mrs. Jennifer W Johnson

Title

Office Manager

Phone

(803) 637-3630

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Peach Tree Medical Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Part of

Edgefield County Hospit

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Self Regional Healthcare Partners

  dba Edgefield Medical Center

  • Rural Health Clinic/Center
  • Edgefield, SC
  • NPI 1639653751

  Sold to, 2019-01-01

  CMS change of ownership

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1417110032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 RIDGE MEDICAL PLAZA",
            "address_2": "SUITE B",
            "city": "EDGEFIELD",
            "state": "SC",
            "postal_code": "298244535",
            "telephone_number": "803-637-3630",
            "fax_number": "803-637-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 RIDGE MEDICAL PLAZA",
            "address_2": "SUITE B",
            "city": "EGEFIELD",
            "state": "SC",
            "postal_code": "298244535",
            "telephone_number": "803-637-3630",
            "fax_number": "803-637-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEFIELD COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDGEFIELD COUNTY HOSPITAL",
        "enumeration_date": "2008-07-03",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-637-3630",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "HTL479",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SC",
            "license": "HTL479",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC548",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Tree Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.