Provider Demographics
NPI:1184673675
Name:UNIVERSITY OF SOUTH CAROLINA SYSTEM
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH CAROLINA SYSTEM
Other - Org Name:UNIVERSITY HEALTH SERVICES DIABETES EDUCATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:RINER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-313-7012
Mailing Address - Street 1:PO BOX 889
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721
Mailing Address - Country:US
Mailing Address - Phone:803-313-7450
Mailing Address - Fax:803-313-7438
Practice Address - Street 1:509 HUBBARD DRIVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-313-7450
Practice Address - Fax:803-313-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPE051Medicaid
SC3827Medicare PIN