1770746059 NPI number — THOMAS B. PACE MD LLC

Table of content: (NPI 1770746059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770746059 NPI number — THOMAS B. PACE MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS B. PACE MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770746059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29616-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-454-7484
Provider Business Mailing Address Fax Number:
864-454-7497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PATEWOOD DRIVE BLD C
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29615-3593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-454-7484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PACE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-454-7484

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  11814 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)