1497816672 NPI number — PEE DEE OBGYN ASSOC., PA

Table of content: (NPI 1497816672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497816672 NPI number — PEE DEE OBGYN ASSOC., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEE DEE OBGYN ASSOC., PA
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:
1497816672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 EAST HWY 76
Provider Second Line Business Mailing Address:
MEDICAL PARK 2 SUITE 2
Provider Business Mailing Address City Name:
MULLINS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29574-6037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-431-2740
Provider Business Mailing Address Fax Number:
843-431-2197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 E HIGHWAY 76
Provider Second Line Business Practice Location Address:
MEDICAL PARK 2 SUITE 2
Provider Business Practice Location Address City Name:
MULLINS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29574-6037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-431-2740
Provider Business Practice Location Address Fax Number:
843-431-2197
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
843-431-2740

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  8727 , 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)

  • Identifier: 9630895 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 02375 . This is a "OFFICE IDENTIFIER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: PA1872 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20000382 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 8902375 . This is a "OFFICE IDENTIFIER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com