Provider Demographics
NPI:1467516690
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:APPALACHIA II CRS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR,THIRD PARTY ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-3720
Mailing Address - Street 1:1751 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2606
Mailing Address - Country:US
Mailing Address - Phone:803-898-0288
Mailing Address - Fax:803-898-0501
Practice Address - Street 1:200 UNIVERSITY RDG
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3635
Practice Address - Country:US
Practice Address - Phone:864-282-4300
Practice Address - Fax:864-282-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDHEC52Medicaid
SC000000157080OtherUNISON HEALTH PLAN OF SC
SC20021675OtherSELECT HEALTH PROVIDER #