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General NPI Number Information
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NPI Number | 1902968316
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Entity Type | Organization
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Legal Business Name | STATE OF SOUTH CAROLINA
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 145 E CHEVES ST
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City | FLORENCE
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State | SC
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Zip | 29506-2526
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Country | US
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Telephone | 843-661-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 1751 CALHOUN ST
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City | COLUMBIA
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State | SC
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Zip | 29201-2606
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Country | US
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Telephone | 803-898-0288
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Fax | 803-898-0501
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Authorized Official
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Title or Position | DIRECTOR, THIRD PARTY ADMINISTRATIO
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Name | MRS. BETTY H GARREN
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Credential |
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Telephone | 803-898-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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