| Edisto Regional Health Services Inc. | |
|
3000 Saint Matthews Rd Orangeburg SC 29118-1442 | |
| (803) 395-2200 | |
| Not Available |
| Full Name | Edisto Regional Health Services Inc. |
|---|---|
| Speciality | Pediatrics |
| Location | 3000 Saint Matthews Rd, Orangeburg, South Carolina |
| Authorized Official Name and Position | Thomas Dandridge (PRESIDENT) |
| Authorized Official Contact | 8033952200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edisto Regional Health Services Inc. Po Box 1245 Orangeburg SC 29116-1245 Ph: (803) 395-4497 | Edisto Regional Health Services Inc. 3000 Saint Matthews Rd Orangeburg SC 29118-1442 Ph: (803) 395-2200 |
| NPI Number | 1285692681 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 05/26/2010 |
| Medicare PECOS PAC ID | 4981693447 |
|---|---|
| Medicare Enrollment ID | O20040810000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285692681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | John H Hayden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598721243 PECOS PAC ID: 0941270565 Enrollment ID: I20040729001115 |
| Provider Name | Timothy S Shaver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275598674 PECOS PAC ID: 4284661869 Enrollment ID: I20050726000274 |
| Provider Name | Alvin L Reaves |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1457337768 PECOS PAC ID: 3072538594 Enrollment ID: I20051013000110 |
| Provider Name | Mieke J Perez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881670305 PECOS PAC ID: 1254344922 Enrollment ID: I20060725000048 |
| Provider Name | William E Oquinn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508870726 PECOS PAC ID: 5496756454 Enrollment ID: I20070118000408 |
| Provider Name | Janice Holloway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811917974 PECOS PAC ID: 9739251406 Enrollment ID: I20080813000925 |
| Provider Name | Brian W Kendall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710963269 PECOS PAC ID: 5294895157 Enrollment ID: I20081121000283 |
| Provider Name | Constance B Simons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740496165 PECOS PAC ID: 5193869022 Enrollment ID: I20100216000664 |
| Provider Name | Thomas Fb Hilliard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346275336 PECOS PAC ID: 9931238227 Enrollment ID: I20100525000578 |
| Provider Name | Steven Murrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457540445 PECOS PAC ID: 0042344475 Enrollment ID: I20101109000786 |
| Provider Name | Yongxin Li |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699867390 PECOS PAC ID: 5991984684 Enrollment ID: I20110127000240 |
| Provider Name | William Leroy Baly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831108919 PECOS PAC ID: 4082896204 Enrollment ID: I20110309000857 |
| Provider Name | William Braswell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952374316 PECOS PAC ID: 6406740760 Enrollment ID: I20110404000673 |
| Provider Name | Antionette Akia Bennett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871769968 PECOS PAC ID: 9739358532 Enrollment ID: I20110812000136 |
| Provider Name | Sarah M Crickman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487882080 PECOS PAC ID: 0648427849 Enrollment ID: I20120822000802 |
| Provider Name | Erin S Castellano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407045404 PECOS PAC ID: 1850548595 Enrollment ID: I20120830000766 |
| Provider Name | Brenda Wilhite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255443891 PECOS PAC ID: 4082792700 Enrollment ID: I20130725000898 |
| Provider Name | Kelenne V Tuitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538419429 PECOS PAC ID: 3476875493 Enrollment ID: I20141202002145 |
| Provider Name | Jaykia Torson Lowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669869467 PECOS PAC ID: 6406161066 Enrollment ID: I20150812006993 |
| Provider Name | Lisa Ann Bozik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831206382 PECOS PAC ID: 3476512955 Enrollment ID: I20151029002945 |
| Provider Name | Robert Francis Webb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699723262 PECOS PAC ID: 7416020052 Enrollment ID: I20151209002542 |
| Provider Name | Cameo Aleece Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366811754 PECOS PAC ID: 6406159078 Enrollment ID: I20160115000002 |
| Provider Name | Rachel S Danford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508101163 PECOS PAC ID: 7113165408 Enrollment ID: I20160623001793 |
| Provider Name | John Alvin Pfeiffer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578537221 PECOS PAC ID: 6507926532 Enrollment ID: I20170220000738 |
| Provider Name | Tara Earthel Hook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871938910 PECOS PAC ID: 8123397767 Enrollment ID: I20170713000470 |
| Provider Name | Lisa F Etheridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245784669 PECOS PAC ID: 1759656242 Enrollment ID: I20171010000678 |
| Provider Name | Karen Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205330065 PECOS PAC ID: 2466717236 Enrollment ID: I20180525001385 |
| Provider Name | Lee C Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982116331 PECOS PAC ID: 8123376738 Enrollment ID: I20180730001680 |
| Provider Name | Melanie Kittrell |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1104312214 PECOS PAC ID: 3173873320 Enrollment ID: I20180910000202 |
| Provider Name | Carinne Shelley Thorne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700270279 PECOS PAC ID: 0941512263 Enrollment ID: I20190529002147 |
| Provider Name | Courtney L Snell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376185314 PECOS PAC ID: 7517391113 Enrollment ID: I20200107000007 |
| Provider Name | Latosha Larkin Corley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376193383 PECOS PAC ID: 7911332796 Enrollment ID: I20200124001852 |
| Provider Name | Brittney N Frazier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366917924 PECOS PAC ID: 0446681829 Enrollment ID: I20200519002815 |
| Provider Name | Elizabeth Ostoja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003006099 PECOS PAC ID: 2163791153 Enrollment ID: I20200624002218 |
| Provider Name | Candace Culler Holstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659046878 PECOS PAC ID: 4486045747 Enrollment ID: I20211221000045 |
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