Provider Demographics
NPI:1689980468
Name:CHESTERFIELD MARLBORO LP
Entity Type:Organization
Organization Name:CHESTERFIELD MARLBORO LP
Other - Org Name:MARLBORO PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL/DIR BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1076 MARLBORO WAY
Mailing Address - Street 2:STE 3
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2495
Mailing Address - Country:US
Mailing Address - Phone:843-479-0432
Mailing Address - Fax:843-479-1261
Practice Address - Street 1:1076 MARLBORO WAY
Practice Address - Street 2:STE 3
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2495
Practice Address - Country:US
Practice Address - Phone:843-479-0432
Practice Address - Fax:843-479-1261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTERFIELD MARLBORO LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health