=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689757239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STATE OF SOUTH CAROLINA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 EAST BOYCE STREET
-----------------------------------------------------
City | MANNING
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-435-8168
-----------------------------------------------------
Fax | 803-435-6825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 OTARRE PKWY
-----------------------------------------------------
City | CAYCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29033-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-898-1553
-----------------------------------------------------
Fax | 803-898-2262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PATIENT BILLING
-----------------------------------------------------
Name | ZANNA PERKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-898-1553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------