Provider Demographics
NPI:1962497891
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:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:DAVID
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 1:3465 LEAPHART RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3029
Practice Address - Country:US
Practice Address - Phone:803-926-0161
Practice Address - Fax:803-926-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65004336332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME063Medicaid
SC1323023OtherBC BS OF TN
SC165226OtherUNISON PROVIDER #
SC82597OtherNORTHWOODS NPN
SC82597OtherNORTHWOODS NPN
SC82597OtherNORTHWOODS NPN