Provider Demographics
NPI:1538481577
Name:SANTEE COOPER URGENT CARE INC
Entity type:Organization
Organization Name:SANTEE COOPER URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-678-6987
Mailing Address - Street 1:POST OFFICE BOX 246
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-0246
Mailing Address - Country:US
Mailing Address - Phone:800-926-3772
Mailing Address - Fax:
Practice Address - Street 1:1013 PROFESSIONAL COURT
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-0246
Practice Address - Country:US
Practice Address - Phone:803-433-7425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care