Provider Demographics
NPI:1114935475
Name:MEDICAL CENTER OF SANTEE LLC
Entity Type:Organization
Organization Name:MEDICAL CENTER OF SANTEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-535-3600
Mailing Address - Street 1:500 BASS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29142
Mailing Address - Country:US
Mailing Address - Phone:803-854-3805
Mailing Address - Fax:803-854-3810
Practice Address - Street 1:500 BASS DRIVE
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142
Practice Address - Country:US
Practice Address - Phone:803-854-3805
Practice Address - Fax:803-854-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QP2300X, 261QR1300X
SCRHC172261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4482Medicaid
SCRHC172Medicaid
SCRHC172Medicaid
SC8944Medicare PIN
SC428986Medicare Oscar/Certification