NPIMap

Organization Active NPI

Fetter Health Care Network, Inc.

Doing business as Fetter Mobile Outreach Vehicle

  • Federally Qualified Health Center (FQHC)
  • Charleston, SC
National Provider Identifier
1679190771
Registry record updated Nov 11, 2025
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.
Doing business as
Fetter Mobile Outreach Vehicle
Practice address
51 Nassau St
Charleston, SC 29403-5513
Phone
(843) 722-4112
Fax
(843) 577-9550
NPI assigned
Jul 6, 2020
Last updated
Nov 11, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
FETTER HEALTH CARE NETWORK, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Authorized official

Name
Aretha R Jones
Title
Chief Executive Officer
Phone
(843) 722-4112

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
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 names 1

  • Fetter Mobile Outreach Vehicle Doing business as

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679190771. Details of each certification follow.

  • CCN 421083 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 421083

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FETTER MOBILE OUTREACH VEHICLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 18, 2020
Last certification
Sep 18, 2020
Ownership / control type
For profit – partnership
Facility address
51 Nassau Street
Charleston, SC 29403

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
Part of
Fetter Health Care Network

NPI Registry JSON

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1679190771",
    "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": "843-577-9550"
        },
        {
            "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": "843-577-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETTER HEALTH CARE NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FETTER HEALTH CARE NETWORK, INC",
        "enumeration_date": "2020-07-06",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ARETHA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "843-722-4112"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fetter Mobile Outreach Vehicle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fetter Mobile Outreach Vehicle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.