Provider Demographics
NPI:1417011586
Name:ENOCH N TSAI, MD PA 111 GREGG AVE
Entity Type:Organization
Organization Name:ENOCH N TSAI, MD PA 111 GREGG AVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENOCH
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-649-7991
Mailing Address - Street 1:111 GREGG AVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2797
Mailing Address - Country:US
Mailing Address - Phone:803-649-7991
Mailing Address - Fax:803-649-7633
Practice Address - Street 1:111 GREGG AVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2797
Practice Address - Country:US
Practice Address - Phone:803-649-7991
Practice Address - Fax:803-649-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7950207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3733Medicaid
SCGP3733Medicaid