Provider Demographics
NPI:1689757239
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:SC DHEC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RECEIVABLES
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:F
Authorized Official - Last Name:QUINTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:803-898-1164
Mailing Address - Street 1:2600 BULL STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1708
Mailing Address - Country:US
Mailing Address - Phone:803-898-1164
Mailing Address - Fax:803-898-2262
Practice Address - Street 1:110 EAST BOYCE STREET
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-435-8168
Practice Address - Fax:803-435-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000155824OtherUNISON HEALTH PLAN OF SC
SC601248OtherSELECT HEALTH PROVIDER #
SCDHEC14Medicaid
SC000000155824OtherUNISON HEALTH PLAN OF SC