1497960355 NPI number — SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL

Table of content: (NPI 1497960355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497960355 NPI number — SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
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:
1497960355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1931 INDUSTRIAL PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-915-8875
Provider Business Mailing Address Fax Number:
843-365-3153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2830 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29526-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-365-3126
Provider Business Practice Location Address Fax Number:
843-365-3153
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
COVIA
Authorized Official Middle Name:
LEVANCE
Authorized Official Title or Position:
REGIONAL HEALTH DIRECTOR
Authorized Official Telephone Number:
843-915-8875

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  23550 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 57-600-286 . This is a "SC DHEC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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