Provider Demographics
NPI:1265643134
Name:PEEDEEHEALTHCARE
Entity Type:Organization
Organization Name:PEEDEEHEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:201 CASHUA ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3301
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:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL00047Medicaid
SCIC0007Medicaid
SCPA6118Medicaid