MEDICARE: SOUTH CAROLINA CANCER SPECIALIST, P.A.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0200X	Oncology Clinic/Center
2	3336C0002X	Clinic Pharmacy
3	207RH0003X	Hematology & Oncology Physician	14194	SC

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DA3698	OTHER	SC	RAILROAD MEDICARE GROUP

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4225377	OTHER	SC	NCPDP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1285633289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA CANCER SPECIALIST, P.A.

Provider Business Mailing Address
First Line	:	836 E 65TH ST STE 22
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4493
Country	:	US
Telephone Number	:	912-819-2146
Fax Number	:	912-819-3320

Provider Business Practice Location Address
First Line	:	45 HOSPITAL CENTER CMNS STE 200
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-2837
Country	:	US
Telephone Number	:	843-689-2895
Fax Number	:	843-689-9270

Authorized Official
Title or Position	:	NETWORK CREDENTIALING COORDINATOR
Name	:	YVETTA P LEE
Credential	:
Telephone Number	:	912-819-2146

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/12/2025

45 HOSPITAL CENTER CMNS
HILTON HEAD ISLAND, SC
29926-2837

Practice Phone: 843-699-2895
Practice Fax: 843-689-9270