NPIMap

Organization Active NPI

Fetter Health Care Network, Inc

  • Federally Qualified Health Center (FQHC)
  • Charleston, SC
National Provider Identifier
1417027244
Registry record updated Apr 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FETTER HEALTH CARE NETWORK, INC
Practice address
51 Nassau St
Charleston, SC 29403-5513
Phone
(843) 722-4112
Fax
(843) 577-8960
NPI assigned
Nov 9, 2006
Last updated
Apr 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2015

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

Authorized official

Name
Mr. Reuben J Pettiford
Title
Executive Director
Phone
(843) 722-4112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

51 Nassau St
Charleston, SC 29403-5513

Mailing address

51 Nassau St
Charleston, SC 29403-5513
Phone (843) 722-4112

Other identifiers 1

IdentifierTypeStateIssuer
CBP015MedicaidSC

Other names 1

  • Franklin C Fetter Family Health Center-Hospitalization Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070507000192 SC Part B Supplier - Clinic/Group Practice 9032215199 Receives reassigned benefits from 91 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Walterboro, SC; Cross, SC; Summerville, SC; North Charleston, SC; N Charleston, SC; Charleston, SC; Johns Island, SC; Hollywood, SC

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429056000000",
    "number": "1417027244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 NASSAU ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035513",
            "telephone_number": "843-722-4112",
            "fax_number": "843-577-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 NASSAU ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035513",
            "telephone_number": "843-722-4112",
            "fax_number": "843-577-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETTER HEALTH CARE NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2015-04-15",
        "status": "A",
        "authorized_official_last_name": "PETTIFORD",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "843-722-4112",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP015",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Franklin C Fetter Family Health Center-Hospitalization",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.