Healthcare Provider Details

I. General information

NPI: 1477496644
Provider Name (Legal Business Name): MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FAIRCHILD ST STE 340
DANIEL ISLAND SC
29492-7602
US

IV. Provider business mailing address

115 FAIRCHILD ST STE 340
DANIEL ISLAND SC
29492-7602
US

V. Phone/Fax

Practice location:
  • Phone: 843-680-1943
  • Fax:
Mailing address:
  • Phone: 843-680-1943
  • 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: WILLIAM R PHIPPS
Title or Position: PLAN PRESIDENT
Credential:
Phone: 843-680-1943