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Clarendon Memorial Hospital

Organization Active NPI Family Medicine Physician · Manning, SC

NPI 1700965217 · NPPES record last updated Jun 30, 2011

Key facts

NPI
1700965217
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
CLARENDON MEMORIAL HOSPITAL
Practice address
50 E. Hospital St.
Suite 4
Manning, SC 29102-3149
Phone
(803) 435-5257
Fax
(803) 435-5259
NPI assigned
Nov 3, 2006
Organization subpart
Yes
Parent organization (as reported)
CLARENDON MEMORIAL HOSPITAL

Authorized official

Name
Mr. Julie Nettles
Title
Director/Division Manager Community
Phone
(803) 435-5270

Corporate family (same tax ID) 13

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

National Provider Directory

Tax ID family
Clarendon EMS (14 organizations share this tax ID)
Part of
Clarendon EMS

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207Q00000X Yes
Obstetrics & Gynecology Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207V00000X
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

50 E. Hospital St.
Suite 4
Manning, SC 29102-3149

Mailing address

50 E. Hospital St.
Suite 4
Manning, SC 29102-3149
Phone (803) 435-5257

Other identifiers

IdentifierTypeStateIssuer
RHC 532MedicaidSC

Other names

  • Manning Medicine and Palmetto Women's Healthcare 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 Jun 30, 2011.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309392000000",
    "number": "1700965217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E. HOSPITAL ST.",
            "address_2": "SUITE 4",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-435-5257",
            "fax_number": "803-435-5259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E. HOSPITAL ST.",
            "address_2": "SUITE 4",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-435-5257",
            "fax_number": "803-435-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARENDON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLARENDON MEMORIAL HOSPITAL",
        "enumeration_date": "2006-11-03",
        "last_updated": "2011-06-30",
        "status": "A",
        "authorized_official_last_name": "NETTLES",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "DIRECTOR/DIVISION MANAGER COMMUNITY",
        "authorized_official_telephone_number": "803-435-5270",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC 532",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manning Medicine and Palmetto Women's Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manning, SC

All providers in Manning, SC · Family Medicine Physician in South Carolina

Sources for this page

Verify at the official NPI Registry.