Provider Demographics
NPI:1356648182
Name:HARTSVILLE DIAGNOSTIC ASSOCIATES PA
Entity Type:Organization
Organization Name:HARTSVILLE DIAGNOSTIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:843-621-7546
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1437
Mailing Address - Country:US
Mailing Address - Phone:843-621-7546
Mailing Address - Fax:
Practice Address - Street 1:214 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4304
Practice Address - Country:US
Practice Address - Phone:843-621-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty