Healthcare Provider Details

I. General information

NPI: 1487610200
Provider Name (Legal Business Name): PEE DEE HEALTHCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201CASHUA STREET
DARLINGTON SC
29532
US

IV. Provider business mailing address

3400 WEST AVE
COLUMBIA SC
29203-6901
US

V. Phone/Fax

Practice location:
  • Phone: 843-393-7452
  • Fax: 843-393-6210
Mailing address:
  • Phone: 803-799-1700
  • Fax: 803-254-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER H COHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 803-799-1700