MEDICARE: STATE OF SOUTH CAROLINA

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	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601233	OTHER	SC	SELECT HEALTH PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000155828	OTHER	SC	UNISON HEALTH PLAN OF SC

General Provider Information

NPI Number	:	1902989163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF SOUTH CAROLINA

Provider Business Mailing Address
First Line	:	400 OTARRE PKWY
Second Line	:
City	:	CAYCE
State	:	SC
Zip	:	29033-3751
Country	:	US
Telephone Number	:	803-898-1553
Fax Number	:	803-898-2262

Provider Business Practice Location Address
First Line	:	500 N MAIN ST STE 9
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-832-0041
Fax Number	:	843-851-9735

Authorized Official
Title or Position	:	DIRECTOR OF PATIENT BILLING
Name	:	ZANNA PERKINS
Credential	:
Telephone Number	:	803-898-1553

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	10/07/2025

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Directions to “STATE OF SOUTH CAROLINA ” Practice Location

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