Healthcare Provider Details

I. General information

NPI: 1982244885
Provider Name (Legal Business Name): HUMANA BENEFIT PLAN OF SOUTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 LAUREL ST
COLUMBIA SC
29201-2660
US

IV. Provider business mailing address

500 W MAIN ST
LOUISVILLE KY
40202-2946
US

V. Phone/Fax

Practice location:
  • Phone: 502-580-1492
  • Fax:
Mailing address:
  • Phone: 502-580-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN WHEATLEY
Title or Position: PRESIDENT, RETAIL SEGMENT
Credential:
Phone: 502-580-2003