Healthcare Provider Details

I. General information

NPI: 1306055025
Provider Name (Legal Business Name): SJC ONCOLOGY SERVICES-SOUTH CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUCKWALTER PLACE BLVD STE 150
BLUFFTON SC
29910-5154
US

IV. Provider business mailing address

PO BOX 11407 DEPT 1623
BIRMINGHAM AL
35246-1623
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-7120
  • Fax: 843-836-7137
Mailing address:
  • Phone: 912-352-1700
  • Fax: 912-352-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY J SCHAACK
Title or Position: CFO/VP, FINANCE
Credential:
Phone: 912-819-6162