1336202381 NPI number — SC DEPT OF DISABILITIES AND SPECIAL NEEDS

Table of content: (NPI 1336202381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336202381 NPI number — SC DEPT OF DISABILITIES AND SPECIAL NEEDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SC DEPT OF DISABILITIES AND SPECIAL NEEDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336202381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POST OFFICE BOX 4706
Provider Second Line Business Mailing Address:
3440 HARDEN STREET EXTENSION
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29240-4706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-898-9600
Provider Business Mailing Address Fax Number:
803-898-9653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 HARDEN STREET EXTENSION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-898-9600
Provider Business Practice Location Address Fax Number:
803-898-9653
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARFIELD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
DEPUTY STATE DIRECTOR ADMINISTRATIO
Authorized Official Telephone Number:
803-898-9743

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0750NH , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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