Provider Demographics
NPI:1003879032
Name:CLEMSON HEALTH CENTER
Entity Type:Organization
Organization Name:CLEMSON HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:REES
Authorized Official - Last Name:HERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-654-6800
Mailing Address - Street 1:885 TIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1480
Mailing Address - Country:US
Mailing Address - Phone:864-654-6800
Mailing Address - Fax:864-654-7672
Practice Address - Street 1:885 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1480
Practice Address - Country:US
Practice Address - Phone:864-654-6800
Practice Address - Fax:864-654-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0967Medicaid
SCGP0967Medicaid