Provider Demographics
NPI:1972737229
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:DHEC HEMOPHILIA-CSHCN PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, THIRD PARTY ADMINISTRATIO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-3720
Mailing Address - Street 1:1751 CALHOUN ST
Mailing Address - Street 2:PO BOX 101106
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2606
Mailing Address - Country:US
Mailing Address - Phone:803-898-0813
Mailing Address - Fax:803-898-0557
Practice Address - Street 1:1751 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2606
Practice Address - Country:US
Practice Address - Phone:803-898-0813
Practice Address - Fax:803-898-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50008287333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy