Provider Demographics
NPI:1609344647
Name:SPECIAL CARE MEDICAL OF SC, INC.
Entity Type:Organization
Organization Name:SPECIAL CARE MEDICAL OF SC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-926-0161
Mailing Address - Street 1:PO BOX 21564
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29221-1564
Mailing Address - Country:US
Mailing Address - Phone:803-926-0161
Mailing Address - Fax:803-926-0345
Practice Address - Street 1:2413A 10TH STREET CT E
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-4008
Practice Address - Country:US
Practice Address - Phone:800-326-3609
Practice Address - Fax:803-926-0161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL CARE MEDICAL OF SC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-07
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2666Medicaid
SCDME063Medicaid