NPIMap

Organization Active NPI

South Carolina Dept of Mental Health Accounting Office

Doing business as Waccamaw Center for Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Conway, SC
National Provider Identifier
1356397228
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE
Doing business as
Waccamaw Center for Mental Health
Practice address
164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Phone
(843) 347-5060
Fax
(843) 347-3959
NPI assigned
May 25, 2006
Last updated
Sep 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy L Turner
Title
Controller
Phone
(803) 898-8503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903

Mailing address

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Phone (843) 347-5060

Other names 1

  • Waccamaw Center for Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000705 SC Part B Supplier - Clinic/Group Practice 9032021175 Receives reassigned benefits from 79 practitioners
3 other NPIs on this enrollment
Practice locations: Orangeburg, SC; North Augusta, SC; Moncks Corner, SC; Georgetown, SC; Loris, SC; Conway, SC; Barnwell, SC; Aiken, SC…

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
South Carolina Department of Mental Health61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2414 Bull St
#3183
Columbia, SC 29201

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
South Carolina Dept of Mental Health Accounting OfficeColumbia, SC, CCN 424005 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 1978
Patrick B Harris Psychiatric HospitalAnderson, SC, CCN 424011 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Sep 7, 2016
Dec 29, 1986
CM Tucker Jr Nursing CareColumbia, SC, CCN 425074 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1970
Jan 1, 1970
C.M. Tucker Jr Nursing Care Center-Roddey PavillionColumbia, SC, CCN 425360 Skilled nursing facility 5% Or Greater Direct Ownership Interest Jan 1, 2006

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 79

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 79

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1356397228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268903",
            "telephone_number": "843-347-5060",
            "fax_number": "843-347-3959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268903",
            "telephone_number": "843-347-5060",
            "fax_number": "843-347-3959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "803-898-8503"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waccamaw Center for Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waccamaw Center for Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.