Provider Demographics
NPI:1447383666
Name:PEDIATRIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:CASTLES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-799-9044
Mailing Address - Street 1:14 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6877
Mailing Address - Country:US
Mailing Address - Phone:803-799-9044
Mailing Address - Fax:803-256-8119
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 410
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6877
Practice Address - Country:US
Practice Address - Phone:803-799-9044
Practice Address - Fax:803-256-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPC074305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization