Provider Demographics
NPI:1639255631
Name:HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
Entity type:Organization
Organization Name:HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-488-6364
Mailing Address - Street 1:123 EAST BROADWAY STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-6438
Mailing Address - Country:US
Mailing Address - Phone:843-386-3573
Mailing Address - Fax:843-386-2617
Practice Address - Street 1:123 EAST BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555-6438
Practice Address - Country:US
Practice Address - Phone:843-386-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC82OtherCITY BUSINESS LICENSE
SC372010Medicaid