Provider Demographics
NPI:1063597987
Name:STATE OF SOUTH CAROLINA
Entity type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PATIENT BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-1553
Mailing Address - Street 1:2100 BULL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2104
Mailing Address - Country:US
Mailing Address - Phone:803-898-1553
Mailing Address - Fax:803-898-2262
Practice Address - Street 1:1228 COLONIAL COMMONS CT.
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-286-9948
Practice Address - Fax:803-286-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC601232OtherSELECT HEALTH PROVIDER #
SCDHEC29Medicaid
SC000000155821OtherUNISON HEALTH PLAN OF SC
SC601232OtherSELECT HEALTH PROVIDER #