Healthcare Provider Details

I. General information

NPI: 1184338592
Provider Name (Legal Business Name): HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6874 SC-908
GRESHAM SC
29546
US

IV. Provider business mailing address

1608 MAIN ST
CONWAY SC
29526-3572
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4700
  • Fax:
Mailing address:
  • Phone: 843-488-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierH8000411
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerFAIN

VIII. Authorized Official

Name: SANTINA MAYO
Title or Position: CEO
Credential:
Phone: 843-488-6364