Provider Demographics
NPI:1063813111
Name:TRIDENT MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:TRIDENT MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-847-4100
Mailing Address - Street 1:5249 EMMETT I. DAVIS JR. AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405
Mailing Address - Country:US
Mailing Address - Phone:843-746-2400
Mailing Address - Fax:843-744-9700
Practice Address - Street 1:5249 EMMETT I. DAVIS JR. AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-746-2400
Practice Address - Fax:843-744-9700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIDENT MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-09
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care