Provider Demographics
NPI:1396700183
Name:SCB INC
Entity type:Organization
Organization Name:SCB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:803-667-1528
Mailing Address - Street 1:54 W SUGARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8042
Mailing Address - Country:US
Mailing Address - Phone:803-667-1528
Mailing Address - Fax:803-667-1528
Practice Address - Street 1:738 UNIVERSITY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7611
Practice Address - Country:US
Practice Address - Phone:803-754-8432
Practice Address - Fax:803-754-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20528261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC205282Medicaid
SC276711Medicaid
SCGP3859Medicaid
SCGP3859Medicaid