Provider Demographics
NPI:1104228311
Name:MANAGEMENT SERVICES OF SANTEE
Entity type:Organization
Organization Name:MANAGEMENT SERVICES OF SANTEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESTER
Authorized Official - Middle Name:SEABROOKS
Authorized Official - Last Name:RAVENELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-854-4106
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29142-0947
Mailing Address - Country:US
Mailing Address - Phone:803-854-4106
Mailing Address - Fax:803-854-5301
Practice Address - Street 1:1580 BASS DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142-0000
Practice Address - Country:US
Practice Address - Phone:803-854-4106
Practice Address - Fax:803-854-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization