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General NPI Number Information
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NPI Number | 1013295740
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Entity Type | Organization
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Legal Business Name | ACA LABORATORIES
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 113 ETIWAN DR
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City | GOOSE CREEK
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State | SC
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Zip | 29445-3073
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Country | US
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Telephone | 843-747-4294
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Fax | 843-747-4298
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Provider Business Mailing Address
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Address Line | PO BOX 1726
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City | GOOSE CREEK
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State | SC
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Zip | 29445-1726
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Country | US
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Telephone | 843-747-4294
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DIMITRI ZIVKO PITOVSKI
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Credential | MD
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Telephone | 843-747-4294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 42D2043357
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License Number State | SC
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