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General NPI Number Information
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NPI Number | 1992851075
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA HEALTH SERVICES
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 OKATIE CENTER BLVD SUITE 125
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City | OKATIE
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State | SC
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Zip | 29909-7507
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Country | US
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Telephone | 843-705-8804
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Fax | 843-705-8950
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Provider Business Mailing Address
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Address Line | PO BOX 403615
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City | ATLANTA
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State | GA
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Zip | 30385-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TERRI-MARIE MAHONEY
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Credential | RN
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Telephone | 843-705-8823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASF-075
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License Number State | SC
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