Basic Information
| Provider Information | |||||||||
| NPI: | 1336423193 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1708 OAK ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295263086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432484700 | ||||||||
| FaxNumber: | 8432483145 | ||||||||
| Practice Location | |||||||||
| Address1: | 1608 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295263572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432484700 | ||||||||
| FaxNumber: | 8432483145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2011 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILDER | ||||||||
| AuthorizedOfficialFirstName: | HUGHIE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8434886020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 42D0857154 | SC | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.