Provider Demographics
NPI:1548280977
Name:SANTEE COOPER OB GYN ASSOC PA
Entity type:Organization
Organization Name:SANTEE COOPER OB GYN ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DORWIN
Authorized Official - Middle Name:TILLMAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-433-7262
Mailing Address - Street 1:1014 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-2827
Mailing Address - Country:US
Mailing Address - Phone:803-433-7262
Mailing Address - Fax:803-433-7271
Practice Address - Street 1:1014 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2827
Practice Address - Country:US
Practice Address - Phone:803-433-7262
Practice Address - Fax:803-433-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0617Medicaid
SCGP0617Medicaid