1851527717 NPI number — FAMILY HEALTH CENTERS, INC. AT COOK ROAD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851527717 NPI number — FAMILY HEALTH CENTERS, INC. AT COOK ROAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTERS, INC. AT COOK ROAD
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:
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:
1851527717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3310 MAGNOLIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29115-1466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-531-6900
Provider Business Mailing Address Fax Number:
803-531-6907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 COOK RD
Provider Second Line Business Practice Location Address:
MEDICAL ARTS CENTER, SUITE 305
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29118-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-536-9394
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CLINICAL SERVICES
Authorized Official Telephone Number:
803-531-6900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  7054 , 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: 070540 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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