Provider Demographics
NPI:1972209120
Name:PAIGE, MACEO P
Entity type:Individual
Prefix:
First Name:MACEO
Middle Name:P
Last Name:PAIGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 DANWOODY RD
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-5349
Mailing Address - Country:US
Mailing Address - Phone:843-624-5091
Mailing Address - Fax:
Practice Address - Street 1:519 DANWOODY RD
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-5349
Practice Address - Country:US
Practice Address - Phone:843-624-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC831257126Medicaid