Provider Demographics
NPI:1285633289
Name:SOUTH CAROLINA CANCER SPECIALIST, P.A.
Entity type:Organization
Organization Name:SOUTH CAROLINA CANCER SPECIALIST, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NETWORK CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-2146
Mailing Address - Street 1:836 E 65TH ST STE 22
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4493
Mailing Address - Country:US
Mailing Address - Phone:912-819-2146
Mailing Address - Fax:912-819-3320
Practice Address - Street 1:45 HOSPITAL CENTER CMNS STE 200
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2837
Practice Address - Country:US
Practice Address - Phone:843-689-2895
Practice Address - Fax:843-689-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QX0200X, 3336C0002X
SC14194207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Single Specialty
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9576Medicaid
SC4225377OtherNCPDP
SCDA3698OtherRAILROAD MEDICARE GROUP
SCGP3117Medicaid
FS0734233OtherDEA