Provider Demographics
NPI:1497817282
Name:MID-CAROLINA INFECTIOUS DISEASES,LLC
Entity Type:Organization
Organization Name:MID-CAROLINA INFECTIOUS DISEASES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-791-3983
Mailing Address - Street 1:169 MEDICAL CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3655
Mailing Address - Country:US
Mailing Address - Phone:803-791-3983
Mailing Address - Fax:803-791-3982
Practice Address - Street 1:169 MEDICAL CIR
Practice Address - Street 2:SUITE C
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3655
Practice Address - Country:US
Practice Address - Phone:803-791-3983
Practice Address - Fax:803-791-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE0429000281Medicare UPIN