Organization
SOUTH CAROLINA DHEC
Active
Other names
Wateree CRS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND DOUGLAS CALVERT (CHIEF OF STAFF)
(803) 898-3305
Entity
Organization
Contact information
Practice address
105 N MAGNOLIA ST, SUMTER, SC 29150-4941
(803) 773-5511
(803) 775-7163
Mailing address
1751 CALHOUN ST, COLUMBIA, SC 29201-2606
(803) 898-0288
(803) 898-0501
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000157080
UNISON HEALTH PLAN OF SC
SC
01
—
20021675
SELECT HEALTH PROVIDER #
SC
05
—
DHEC55
—
SC
Enumeration date
12/19/2006
Last updated
08/22/2020
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