Provider Demographics
NPI:1275825994
Name:PECORA MEDICAL, PC
Entity Type:Organization
Organization Name:PECORA MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANAMENO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:864-225-7401
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0357
Mailing Address - Country:US
Mailing Address - Phone:864-225-7401
Mailing Address - Fax:864-225-7201
Practice Address - Street 1:803 N FANT ST STE 3A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5718
Practice Address - Country:US
Practice Address - Phone:864-225-7401
Practice Address - Fax:864-225-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8549Medicaid