Basic Information
| Provider Information | |||||||||
| NPI: | 1912659954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SC MEDICAL SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7235 BLYTHDALE DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752481551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692153494 | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 S ASSEMBLY ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292014545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692153494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2022 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4692153494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.