Healthcare Provider Details

I. General information

NPI: 1669697124
Provider Name (Legal Business Name): PEE DEE HEALTH CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CASHUA ST
DARLINGTON SC
29532-3301
US

IV. Provider business mailing address

3400 WEST AVE
COLUMBIA SC
29203-6901
US

V. Phone/Fax

Practice location:
  • Phone: 843-393-7452
  • Fax:
Mailing address:
  • Phone: 803-799-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONY MEGNA
Title or Position: CEO-LEGAL COUNCIL
Credential:
Phone: 803-799-1700