Provider Demographics
NPI:1578516043
Name:UNION HOSPITAL DISTRICT CAROLINAS HEALTH ASSOCIATES - SOUTH M
Entity Type:Organization
Organization Name:UNION HOSPITAL DISTRICT CAROLINAS HEALTH ASSOCIATES - SOUTH M
Other - Org Name:CENTER FOR FAMILY HEALTHCARE, P. A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-429-2601
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-2717
Mailing Address - Country:US
Mailing Address - Phone:864-429-8029
Mailing Address - Fax:864-429-3515
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2717
Practice Address - Country:US
Practice Address - Phone:864-429-8029
Practice Address - Fax:864-429-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1304Medicaid
SC20020245OtherSELECT HEALTH MEDICAID HO
SCDG6642OtherMEDICARE RAILROAD
SCDG6642OtherRAILROAD MEDICARE
SCDG6642OtherMEDICARE RAILROAD
SCDG6642OtherMEDICARE RAILROAD