Provider Demographics
NPI:1982244885
Name:HUMANA BENEFIT PLAN OF SOUTH CAROLINA, INC.
Entity Type:Organization
Organization Name:HUMANA BENEFIT PLAN OF SOUTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, RETAIL SEGMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-580-2003
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2946
Mailing Address - Country:US
Mailing Address - Phone:502-580-1492
Mailing Address - Fax:
Practice Address - Street 1:1703 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2660
Practice Address - Country:US
Practice Address - Phone:502-580-1492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMANA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization