Fetter Health Care Network, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Charleston, SC
NPI 1982124301 · NPPES record last updated Jun 27, 2017
Key facts
- NPI
- 1982124301
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FETTER HEALTH CARE NETWORK, INC.
- Practice address
- 35 Walnut St
Charleston, SC 29403-4514 - Phone
- (843) 722-4112
- NPI assigned
- Jun 27, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- FETTER HEALTH CARE NETWORK, INC.
Authorized official
- Name
- Aretha Jones
- Title
- Ceo
- Phone
- (843) 722-4112
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 14
Practitioners 83
-
Caitlin Wells Briggs, APRN
-
Mary Elizabeth Creed, APRN, FNP-C
-
Richetta Deas, ANP-C
-
Charles Effiong, MD
-
Wakesha T Evans, PA-C
-
Terri Olivia Fowler, F.N.P.
-
Pamela Sherl Johnson, FNP APRN
-
Dana Annette Laforte, APRN-FNP
-
Dennis Tambe Besong, M.D.
-
Allahna Allybia Coggins, M.D.
-
Christopher Bowers, PA-C
-
Anna Suzette Callahan, MA, LPC
-
Nancy Elizabeth Crossley, M.D.
-
Joann Csakany, MD
-
Lundy Davis, PA-C
-
James Junius Dove, PAC
-
Colin Lee Echard, PA-C
-
Tonya M Farless, PA
-
Lindsay Denise Foley, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Federally qualified health center certification: CCN 421051
- Legal name
- FETTER HEALTH CARE NETWORK INC
- Doing business as
- ONE 80 PLACE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 6, 2017
- Last certification
- Oct 6, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 8, 1975 in SC
- Enrollment address
- 35 Walnut Street
Charleston, SC 29403
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Darlene E Wright |
Corporate Officer |
Jan 1, 2014 | |
| Enid B Jenkins |
Corporate Officer |
Jan 1, 2014 | |
| Aretha Powers |
Corporate Director |
Apr 11, 2016 | |
| W-2 Managing Employee |
Aug 16, 2017 | ||
| Sonya B Jones |
Corporate Officer |
Jan 1, 2014 | |
| Deborah C Williamson |
Corporate Officer |
Jan 1, 2014 | |
| Phalarma Freeman |
Corporate Officer |
Jan 1, 2014 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Fetter Health Care Network Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Sep 18, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171006002377 | SC | Part a Provider - Federally Qualified Health Center (FQHC) | 9032215199 | Practice locations: Charleston, SC |
| O20171228002000 | SC | Part B Supplier - Clinic/Group Practice | 9032215199 |
Receives reassigned benefits from 71 practitioners Practice locations: Charleston, SC |
National Provider Directory
- Part of
- Fetter Health Care Network Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
35 Walnut St
Charleston, SC 29403-4514
Mailing address
51 Nassau St
Charleston, SC 29403-5513
Phone (843) 722-4112
Other names
- One 80 Place
Other providers in Charleston, SC
- Fetter Health Care Network, Inc.
- Fetter Health Care Network, Inc.
- Fetter Health Care Network, Inc.
- Fetter Health Care Network, Inc.
- Fetter Health Care Network, Inc.
- Derek John Feussner
- John R Feussner
- Kellie Few Dupree
- Taylor Fewox
- Lisa M Fickle
All providers in Charleston, SC · Federally Qualified Health Center (FQHC) in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.