Provider Demographics
NPI:1003994153
Name:STATE OF SOUTH CAROLINA
Entity type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-1553
Mailing Address - Street 1:400 OTARRE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3751
Mailing Address - Country:US
Mailing Address - Phone:803-898-1553
Mailing Address - Fax:803-898-2262
Practice Address - Street 1:407 N SALEM AVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4115
Practice Address - Country:US
Practice Address - Phone:803-773-5511
Practice Address - Fax:803-773-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2025-10-07
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 #
SCDHEC43Medicaid
SCQ291310004Medicare PIN