Provider Demographics
NPI:1457592933
Name:SOUTHERN CROSS PSYCHIATRIC SERVICES OF SOUTH CAROLINA, INC.
Entity Type:Organization
Organization Name:SOUTHERN CROSS PSYCHIATRIC SERVICES OF SOUTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-749-2940
Mailing Address - Street 1:1203 48TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5425
Mailing Address - Country:US
Mailing Address - Phone:843-449-7105
Mailing Address - Fax:843-449-5090
Practice Address - Street 1:1203 48TH AVE N STE 202
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5425
Practice Address - Country:US
Practice Address - Phone:843-449-7105
Practice Address - Fax:843-449-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC54551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9213Medicare PIN