Provider Demographics
NPI:1447308119
Name:FETTER HEALTH CARE NETWORK INC
Entity type:Organization
Organization Name:FETTER HEALTH CARE NETWORK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-722-4112
Mailing Address - Street 1:51 NASSAU STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5513
Mailing Address - Country:US
Mailing Address - Phone:843-722-4112
Mailing Address - Fax:843-577-8960
Practice Address - Street 1:302 MEDICAL PARK DR
Practice Address - Street 2:SUITE 111
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-5747
Practice Address - Country:US
Practice Address - Phone:843-549-6853
Practice Address - Fax:843-549-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC047Medicaid
SC421855Medicare Oscar/Certification
SC421855Medicare UPIN