Healthcare Provider Details

I. General information

NPI: 1639255631
Provider Name (Legal Business Name): HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EAST BROADWAY STREET
JOHNSONVILLE SC
29555-6438
US

IV. Provider business mailing address

123 EAST BROADWAY STREET
JOHNSONVILLE SC
29555-6438
US

V. Phone/Fax

Practice location:
  • Phone: 843-386-3573
  • Fax:
Mailing address:
  • Phone: 843-386-3573
  • Fax: 843-386-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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