Provider Demographics
NPI:1275750549
Name:PEE DEE HEALTH CARE, PA
Entity Type:Organization
Organization Name:PEE DEE HEALTH CARE, PA
Other - Org Name:DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-799-1700
Mailing Address - Street 1:201 CASHUA ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3301
Mailing Address - Country:US
Mailing Address - Phone:843-393-7452
Mailing Address - Fax:
Practice Address - Street 1:3400 WEST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6901
Practice Address - Country:US
Practice Address - Phone:803-799-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1441Medicaid
SCDE1441Medicaid