Provider Demographics
NPI:1609924752
Name:SOUTH CENTRAL COMMUNITY SERVICES AGENCY
Entity Type:Organization
Organization Name:SOUTH CENTRAL COMMUNITY SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-375-5000
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38402-0459
Mailing Address - Country:US
Mailing Address - Phone:931-375-5000
Mailing Address - Fax:931-375-2011
Practice Address - Street 1:1400 COLLEGE PARK DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-375-5000
Practice Address - Fax:931-375-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000209Medicaid