Healthcare Provider Details

I. General information

NPI: 1528262888
Provider Name (Legal Business Name): FAMILY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 CHESTNUT ST
SAINT MATTHEWS SC
29135-8104
US

IV. Provider business mailing address

558 CHESTNUT ST
SAINT MATTHEWS SC
29135-8104
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-6900
  • Fax: 803-531-6907
Mailing address:
  • Phone: 803-531-6900
  • Fax: 803-531-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONDRE WILSON
Title or Position: CFO
Credential:
Phone: 803-531-6900