Scotland Memorial Hospital Inc
Organization Active NPI Rural Health Clinic/Center · Bennettsville, SC
NPI 1770577611 · NPPES record last updated Aug 8, 2022
Key facts
- NPI
- 1770577611
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SCOTLAND MEMORIAL HOSPITAL INC
- Practice address
- 957 Cheraw St
Bennettsville, SC 29512-2420 - Phone
- (843) 454-0245
- Fax
- (843) 479-7873
- NPI assigned
- Sep 7, 2005
- Organization subpart
- No
Authorized official
- Name
- Lucien Stonge
- Title
- Cfo
- Phone
- (864) 366-3310
Owners & managing parties with NPI records 14
-
Plummer Ray Chavis, D.D.S.
-
Bradford K Faulkenberry, M.D.
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 10
Related certifications (CCN) 1
Facilities with the same owner 8
Practitioners 275
-
Terri B Cowan, PA-C
-
Twyla Cummings, MD
-
Latonya Armstrong, CNM
-
Samuel M Cummings, M.D.
-
Tekisha Rina Freeman, FNP
-
Matthew T Manzo, DO
-
Linda K Mitchell-Frye, M.D.
-
Patrice L High, D.O.
-
Gyetri Mitchell, MSN, FNP
-
Holly Hunt Rowell, FNP
-
Amber Ann Wallace, M.D.
-
Kim D Lopes, CNM
-
Jadene Lowry, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0976820 | Marlboro Family Practice and Urgent Care | Provider-performed microscopy | Aug 14, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC, NC
Rural health clinic certification: CCN 423461
- Legal name
- SCOTLAND MEMORIAL HOSPITAL, INC
- Doing business as
- MARLBORO FAMILY PRACTICE AND URGENT CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 24, 2017
- Last certification
- Aug 24, 2017
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 26, 1947 in NC
- Enrollment address
- 957 Cheraw St
Bennettsville, SC 29512-2420 - Related CCNs
- 340008
All disclosed owners & managing parties 25
| Name | Role | Since | Share |
|---|---|---|---|
| Milton Farmer |
Corporate Director | Jan 1, 2009 | |
| Scotland Memorial Hospital, Inc |
Operational/Managerial Control | Dec 1, 2015 | |
| Pamela Ashley |
Corporate Officer |
Apr 1, 2009 | |
| Gregory Clark Wood |
Contracted Managing Employee |
Apr 1, 2009 | |
| Corporate Officer |
Apr 1, 2009 | ||
| Matthew David Pracht |
Contracted Managing Employee | Apr 1, 2009 | |
| Corporate Officer | Apr 1, 2009 | ||
| Ronald Mercer |
Corporate Director | Jan 1, 2011 | |
| David Harling |
Corporate Director | Jan 1, 2010 | |
| Jane Rogers |
Corporate Officer |
Jan 1, 2016 | |
| Corporate Director | Jan 1, 2010 | ||
| Bradford Keith Faulkenberry |
Corporate Director | Jan 1, 2016 | |
| Kenneth Nichols |
Corporate Director | Jan 1, 2015 | |
| Michael Odonnell |
Corporate Director | Jan 1, 2009 | |
| Plummer R Chavis |
Corporate Director | Jan 1, 2008 | |
| Nancy Louise Walker |
Corporate Director | Jan 1, 2010 | |
| Donna M Richardson |
Corporate Director | Jan 1, 2012 | |
| Kyle Chavis |
Corporate Director | Jan 1, 2010 | |
| Stephen L Lanuti |
Corporate Director | Jan 1, 2014 | |
| Joshua Malcolm |
Corporate Director | Jan 1, 2011 | |
| Michael Vinson |
Corporate Officer | Jan 1, 2016 | |
| Corporate Director | Jan 1, 2007 | ||
| Dennis Stone |
Corporate Director | Jan 1, 2015 | |
| Wilbur Gene Shytle |
Corporate Director | Jan 1, 2013 | |
| John Ray Nobles |
Corporate Director | Jan 1, 2016 | |
| Robert N Hinson |
Corporate Director | Jan 1, 2014 | |
| Rebecca Hughes |
Corporate Director | Jan 1, 2014 | |
| Charlotte-Mecklenburg Hospital Authority |
Operational/Managerial Control | Apr 9, 2009 | |
| Henry Allen McLaurin |
Corporate Director | Jan 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080304000638 | SC | Part B Supplier - Clinic/Group Practice | 0648208504 |
Receives reassigned benefits from 27 practitioners 3 other NPIs on this enrollment Practice locations: Bennettsville, SC |
| O20180622001263 | NC | Part a Provider - Rural Health Clinic | 0648208504 | Practice locations: Bennettsville, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| General Practice Physician |
208D00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
957 Cheraw St
Bennettsville, SC 29512-2420
Mailing address
PO Box 2257
Laurinburg, NC 28353-2257
Phone (843) 454-0245
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2129 | Medicaid | SC | |
| 79011P9 | Medicaid | NC |
Other names
- MARLBORO FAMILY PRACTICE AND URGENT CARE
Other providers in Bennettsville, SC
- Gilberto Sanchez Jr.
- SC Department of Juvenile Justice
- SC Dept. of Mental Health
- Scotland Memorial Hospital
- Scotland Memorial Hospital Inc
- Scotland Memorial Hospital, Inc.
- Scotland Orthopedics, PA
- Scotland Regional Health Network
- Aimee Elizabeth Seals
- Jennifer Self
All providers in Bennettsville, SC · Rural Health Clinic/Center in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.