MEDICARE: SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3000641104	OTHER	SC	WORKER'S COMP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841374972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE

Provider Business Mailing Address
First Line	:	108 PALMETTO PARK BLVD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7968
Country	:	US
Telephone Number	:	803-996-1500
Fax Number	:	803-359-2995

Provider Business Practice Location Address
First Line	:	301 PALMETTO PARK BLVD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7872
Country	:	US
Telephone Number	:	803-996-1500
Fax Number	:	803-359-2995

Authorized Official
Title or Position	:	CONTOLLER
Name	:	TRACY L TURNER
Credential	:
Telephone Number	:	803-898-8503

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/02/2024

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