Provider Demographics
NPI:1457415259
Name:SOUTH CAROLINA DHEC
Entity Type:Organization
Organization Name:SOUTH CAROLINA DHEC
Other - Org Name:WATEREE CRS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-898-3305
Mailing Address - Street 1:1751 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2606
Mailing Address - Country:US
Mailing Address - Phone:803-898-0288
Mailing Address - Fax:803-898-0501
Practice Address - Street 1:105 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4941
Practice Address - Country:US
Practice Address - Phone:803-773-5511
Practice Address - Fax:803-775-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDHEC55Medicaid
SC000000157080OtherUNISON HEALTH PLAN OF SC
SC20021675OtherSELECT HEALTH PROVIDER #