Provider Demographics
NPI:1053486050
Name:JCA INC
Entity Type:Organization
Organization Name:JCA INC
Other - Org Name:NATIONAL MEN'S HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-736-9400
Mailing Address - Street 1:115 BLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6251
Mailing Address - Country:US
Mailing Address - Phone:803-736-9400
Mailing Address - Fax:803-736-6999
Practice Address - Street 1:115 BLARNEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6251
Practice Address - Country:US
Practice Address - Phone:803-736-9400
Practice Address - Fax:803-736-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17898261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service