Provider Demographics
NPI:1063713451
Name:UNIVERSITY OF SOUTH CAROLINA
Entity type:Organization
Organization Name:UNIVERSITY OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF BUSINESS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CIA, CHFP, MBA
Authorized Official - Phone:803-733-3213
Mailing Address - Street 1:CENTER FOR DISABILITY RESOURCES, PEDIATRICS
Mailing Address - Street 2:SCHOOL OF MEDICINE, UNIVERSITY OF SOUTH CAROLINA
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-0001
Mailing Address - Country:US
Mailing Address - Phone:803-434-7950
Mailing Address - Fax:803-434-8606
Practice Address - Street 1:8301 FARROW ROAD
Practice Address - Street 2:COLLABORATIVE BUILDING A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3245
Practice Address - Country:US
Practice Address - Phone:803-434-7950
Practice Address - Fax:803-434-8606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-09-5360251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health