Provider Demographics
NPI:1164531349
Name:LOWCOUNTRY PEDIATRICS
Entity Type:Organization
Organization Name:LOWCOUNTRY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:KLECKNER
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-572-3300
Mailing Address - Street 1:101 SPRINGHALL DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5336
Mailing Address - Country:US
Mailing Address - Phone:843-572-3300
Mailing Address - Fax:843-797-3331
Practice Address - Street 1:101 SPRINGHALL DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5336
Practice Address - Country:US
Practice Address - Phone:843-572-3300
Practice Address - Fax:843-797-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1994738174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3682Medicaid