Provider Demographics
NPI:1548215577
Name:MOUNT PLEASANT OB/GYN, PA
Entity Type:Organization
Organization Name:MOUNT PLEASANT OB/GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TABAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-0301
Mailing Address - Street 1:1400 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3255
Mailing Address - Country:US
Mailing Address - Phone:843-884-0301
Mailing Address - Fax:843-884-9620
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3255
Practice Address - Country:US
Practice Address - Phone:843-884-0301
Practice Address - Fax:843-884-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0418Medicaid
SCE91375Medicare UPIN
SC3936Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
SCB92155Medicare UPIN
SCD90764Medicare UPIN
SCGP0418Medicaid
SCH62276Medicare UPIN