Provider Demographics
NPI:1497960355
Name:SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Entity Type:Organization
Organization Name:SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Other - Org Name:REGION 6 DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COVIA
Authorized Official - Middle Name:LEVANCE
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MDIV
Authorized Official - Phone:843-915-8875
Mailing Address - Street 1:1931 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526
Mailing Address - Country:US
Mailing Address - Phone:843-915-8875
Mailing Address - Fax:843-365-3153
Practice Address - Street 1:2830 OAK ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4560
Practice Address - Country:US
Practice Address - Phone:843-365-3126
Practice Address - Fax:843-365-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23550261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-600-286OtherSC DHEC