Provider Demographics
NPI:1104259340
Name:SOUTH CAROLINA DEPARTMENT OF CORRECTIONS
Entity type:Organization
Organization Name:SOUTH CAROLINA DEPARTMENT OF CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRANHAM
Authorized Official - Last Name:TOMARCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-896-1233
Mailing Address - Street 1:4444 BROAD RIVER RD
Mailing Address - Street 2:P. O. BOX 21787
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4012
Mailing Address - Country:US
Mailing Address - Phone:803-896-2707
Mailing Address - Fax:
Practice Address - Street 1:4444 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4012
Practice Address - Country:US
Practice Address - Phone:803-896-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty