| Organization Name: | STATE OF SOUTH CAROLINA |
| NPI Number: | 1447331822 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BETTY H GARREN (DIRECTOR, THIRD PARTY ADMINISTRATIO) |
| Mailing Address: | 11015 Ellenton Street, Hwy 278 Barnwell |
| State: | SC US |
| Postal Code: | 29812 |
| Phone Number: | 8035411061 |
| Fax Number: | |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 05/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |