NPIMap

Organization Active NPI

Edisto Regional Health Services Inc

  • Clinic/Center
  • Holly Hill, SC
National Provider Identifier
1609198613
Registry record updated Feb 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EDISTO REGIONAL HEALTH SERVICES INC
Practice address
185 Bunch Ford Road
Holly Hill, SC 29059-1640
Phone
(803) 395-4497
NPI assigned
Feb 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2010

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

Authorized official

Name
Lisa M Goodlett
Title
C.O.O.
Phone
(803) 395-2462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X SC Primary

Addresses

Primary practice location

185 Bunch Ford Road
Holly Hill, SC 29059-1640

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4497

Other names 1

  • Holly Hill Diagnostic Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000307 SC Part B Supplier - Clinic/Group Practice 4981693447 Receives reassigned benefits from 41 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowman, SC; Bamberg, SC; Santee, SC; Saint Matthews, SC; Orangeburg, SC; Holly Hill, SC; Branchville, SC

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Low Country Pain Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266364800000",
    "number": "1609198613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 BUNCH FORD ROAD",
            "city": "HOLLY HILL",
            "state": "SC",
            "postal_code": "290591640",
            "telephone_number": "803-395-4497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO REGIONAL HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-17",
        "last_updated": "2010-02-17",
        "status": "A",
        "authorized_official_last_name": "GOODLETT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "803-395-2462"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holly Hill Diagnostic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.