Provider Demographics
NPI:1265404743
Name:ABBEVILLE COUNTY SCHOOL DISTRICT
Entity type:Organization
Organization Name:ABBEVILLE COUNTY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-366-5427
Mailing Address - Street 1:400 GREENVILLE ST.
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620
Mailing Address - Country:US
Mailing Address - Phone:864-336-5427
Mailing Address - Fax:864-366-8531
Practice Address - Street 1:400 GREENVILLE ST.
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620
Practice Address - Country:US
Practice Address - Phone:864-336-5427
Practice Address - Fax:864-366-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCW01869SC1Medicaid
SCW01868SC1Medicaid
SCW05389SC1Medicaid
SCW005755SC1Medicaid
SCW01870SC1Medicaid
SCW05388SC1Medicaid