Basic Information
| Provider Information | |||||||||
| NPI: | 1639255631 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 EAST BROADWAY STREET | ||||||||
| Address2: | |||||||||
| City: | JOHNSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295556438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433863573 | ||||||||
| FaxNumber: | 8433862617 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 EAST BROADWAY STREET | ||||||||
| Address2: | |||||||||
| City: | JOHNSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295556438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433863573 | ||||||||
| FaxNumber: | 8433862617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | EUBANKS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 8434886363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 82 | 01 | SC | CITY BUSINESS LICENSE | OTHER |