Contract Details
Ancillary Care Services
Facility name
Special Care Medical of South Carolina
Provider ID
P000005713
NPI
1962497891
Tax ID
570818783
Effective Date
4/1/2012
Last Updated
10/17/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
5931 Rivers Avenue Suite 102
North Charleston, SC 29406
United States
County
Charleston
Phone
8437451815 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address