Provider Demographics
NPI:1447382692
Name:ST JAMES HEALTH AND WELLNESS INC
Entity Type:Organization
Organization Name:ST JAMES HEALTH AND WELLNESS INC
Other - Org Name:ST. JAMES-SANTEE FAMILY HEALTH CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-990-7993
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0608
Mailing Address - Country:US
Mailing Address - Phone:843-887-3274
Mailing Address - Fax:843-887-3929
Practice Address - Street 1:8189 CHOPPEE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-6374
Practice Address - Country:US
Practice Address - Phone:843-545-8723
Practice Address - Fax:843-545-8346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JAMES HEALTH AND WELLNESS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421877Medicare ID - Type Unspecified