Provider Demographics
NPI:1972693885
Name:STATE OF SOUTH CAROLINA
Entity type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-1553
Mailing Address - Street 1:2100 BULL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2104
Mailing Address - Country:US
Mailing Address - Phone:803-898-1553
Mailing Address - Fax:803-898-2262
Practice Address - Street 1:3685 RIVERS AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8062
Practice Address - Country:US
Practice Address - Phone:843-579-4500
Practice Address - Fax:843-953-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000155828OtherUNISON HEALTH PLAN OF SC
SC601233OtherSELECT HEALTH PROVIDER #
SCDHEC10Medicaid
SCQ291310007Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER