Provider Demographics
NPI:1487711958
Name:SOUTH CAROLINA DHEC
Entity type:Organization
Organization Name:SOUTH CAROLINA DHEC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-3305
Mailing Address - Street 1:1751 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2606
Mailing Address - Country:US
Mailing Address - Phone:803-898-0288
Mailing Address - Fax:803-898-0501
Practice Address - Street 1:4050 BRIDGE VIEW DR
Practice Address - Street 2:SUITE 600
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7488
Practice Address - Country:US
Practice Address - Phone:843-792-3561
Practice Address - Fax:843-792-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000157080OtherUNISON HEALTH PLAN OF SC
SC20021675OtherSELECT HEALTH PROVIDER #
SCDHEC49Medicaid