Provider Demographics
NPI:1306055025
Name:SJC ONCOLOGY SERVICES-SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:SJC ONCOLOGY SERVICES-SOUTH CAROLINA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-6162
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT 1623
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1623
Mailing Address - Country:US
Mailing Address - Phone:912-352-1700
Mailing Address - Fax:912-352-1066
Practice Address - Street 1:100 BUCKWALTER PLACE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5154
Practice Address - Country:US
Practice Address - Phone:843-836-7120
Practice Address - Fax:843-836-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCC0817OtherRAILROAD MEDICARE
SC114450Medicaid
SCGP5359Medicaid
GA000360533AMedicaid
GA581690520AMedicare ID - Type UnspecifiedDR MORRIS GEFFEN
GA000360533AMedicaid
SCCC0817OtherRAILROAD MEDICARE
H31440Medicare UPIN
SC3958Medicare UPIN
SCI34568Medicare UPIN
SC3958Medicare PIN
SCGP5359Medicaid