Provider Demographics
NPI:1487610200
Name:PEE DEE HEALTHCARE PA
Entity type:Organization
Organization Name:PEE DEE HEALTHCARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:H
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-799-1700
Mailing Address - Street 1:3400 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6901
Mailing Address - Country:US
Mailing Address - Phone:803-799-1700
Mailing Address - Fax:803-254-3678
Practice Address - Street 1:201CASHUA STREET
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532
Practice Address - Country:US
Practice Address - Phone:843-393-7452
Practice Address - Fax:843-393-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC037Medicaid
SC423848Medicare Oscar/Certification
SCRHC037Medicaid