Organization
SOUTH CAROLINA DHEC
Active
Other names
Trident 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
4050 BRIDGE VIEW DR, SUITE 600, CHARLESTON, SC 29405-7488
(843) 792-3561
(843) 792-4695
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
—
DHEC49
—
SC
Enumeration date
01/03/2007
Last updated
08/22/2020
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