Healthcare Provider Details

I. General information

NPI: 1396700183
Provider Name (Legal Business Name): SCB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 UNIVERSITY VILLAGE DR
BLYTHEWOOD SC
29016-7611
US

IV. Provider business mailing address

54 W SUGARBERRY CT
BLYTHEWOOD SC
29016-8042
US

V. Phone/Fax

Practice location:
  • Phone: 803-754-8432
  • Fax: 803-754-8411
Mailing address:
  • Phone: 803-667-1528
  • Fax: 803-667-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number20528
License Number StateSC

VIII. Authorized Official

Name: DR. STEVEN K BARNETT
Title or Position: PRESIDENT
Credential: M. D.
Phone: 803-667-1528