Basic Information
| Provider Information | |||||||||
| NPI: | 1295861268 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WALLACE THOMSON HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293792839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644270351 | ||||||||
| FaxNumber: | 8644292676 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293792839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644270351 | ||||||||
| FaxNumber: | 8644292676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | RUSH | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8644290351 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 400391 | 05 | SC | MEDICAID |