Provider Demographics
NPI:1679829949
Name:THE METHODIST OAKS
Entity Type:Organization
Organization Name:THE METHODIST OAKS
Other - Org Name:THE OAKS PACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-534-1212
Mailing Address - Street 1:153 FOUNDERS CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2087
Mailing Address - Country:US
Mailing Address - Phone:803-268-5300
Mailing Address - Fax:803-268-5302
Practice Address - Street 1:153 FOUNDERS CT
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2087
Practice Address - Country:US
Practice Address - Phone:803-268-5300
Practice Address - Fax:803-268-5302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE METHODIST OAKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH0105OtherCMS CONTRACT NUMBER