Healthcare Provider Details

I. General information

NPI: 1114935475
Provider Name (Legal Business Name): MEDICAL CENTER OF SANTEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BASS DRIVE
SANTEE SC
29142
US

IV. Provider business mailing address

500 BASS DRIVE
SANTEE SC
29142
US

V. Phone/Fax

Practice location:
  • Phone: 803-854-3805
  • Fax: 803-854-3810
Mailing address:
  • Phone: 803-854-3805
  • Fax: 803-854-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MONNIE SINGLETON
Title or Position: MANAGER
Credential: MD
Phone: 803-535-3600