Organization
STATE OF SOUTH CAROLINA
Active
Other names
Appalachia III CRS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTY H GARREN (DIRECTOR, THIRD PARTY ADMINISTRATIO)
(803) 898-3720
Entity
Organization
Contact information
Practice address
151 E WOOD ST, SPARTANBURG, SC 29303-3016
(864) 596-2227
(864) 596-3316
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
—
DHEC 54
—
SC
Enumeration date
12/19/2006
Last updated
05/09/2012
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