Provider Demographics
NPI:1396881066
Name:AFFINITY HEALTH CENTER
Entity type:Organization
Organization Name:AFFINITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-909-9720
Mailing Address - Street 1:455 LAKESHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4205
Mailing Address - Country:US
Mailing Address - Phone:803-909-6363
Mailing Address - Fax:803-909-6364
Practice Address - Street 1:455 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4205
Practice Address - Country:US
Practice Address - Phone:803-909-6363
Practice Address - Fax:803-909-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42-1033261QF0400X
SC55006721261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7103Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER