Provider Demographics
NPI:1326246695
Name:CHARLESTON MEDICAL CLINIC
Entity Type:Organization
Organization Name:CHARLESTON MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:883-723-4328
Mailing Address - Street 1:38 RADCLIFFE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6146
Mailing Address - Country:US
Mailing Address - Phone:843-723-4328
Mailing Address - Fax:843-722-8303
Practice Address - Street 1:38 RADCLIFFE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-6146
Practice Address - Country:US
Practice Address - Phone:843-723-4328
Practice Address - Fax:843-722-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC9366261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3530Medicaid
SCPA3530Medicaid