Provider Demographics
NPI:1598263097
Name:PLANTATION PEDIARTICS, LLC
Entity Type:Organization
Organization Name:PLANTATION PEDIARTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-766-6308
Mailing Address - Street 1:1871 SAVAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4726
Mailing Address - Country:US
Mailing Address - Phone:843-531-9961
Mailing Address - Fax:
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4795
Practice Address - Country:US
Practice Address - Phone:843-531-9961
Practice Address - Fax:843-531-9961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANTATION PEDIARTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty