Provider Demographics
NPI:1992851075
Name:SOUTH CAROLINA HEALTH SERVICES
Entity Type:Organization
Organization Name:SOUTH CAROLINA HEALTH SERVICES
Other - Org Name:BLUFFTON OKATIE OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-705-8823
Mailing Address - Street 1:PO BOX 403615
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30385-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 OKATIE CENTER BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7507
Practice Address - Country:US
Practice Address - Phone:843-705-8804
Practice Address - Fax:843-705-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-075261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC246Medicaid
SCP00112549OtherRAILROAD MEDICARE
SC=========-003OtherBCBS-PPC