1548296098 NPI number — PEE DEEDIABETIC CONSULTANTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548296098 NPI number — PEE DEEDIABETIC CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEE DEEDIABETIC CONSULTANTS
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:
1548296098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 ACADEMY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29560-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-394-3121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29560-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-394-3121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PLAYER
Authorized Official First Name:
JANE
Authorized Official Middle Name:
DIXON
Authorized Official Title or Position:
ADMINISTRATOR/OWNER
Authorized Official Telephone Number:
843-394-3121

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  CDE 136743 , 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)





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