Provider Demographics
NPI:1710146212
Name:PEE DEE PATHOLOGY ASSOCIATES INC.
Entity Type:Organization
Organization Name:PEE DEE PATHOLOGY ASSOCIATES INC.
Other - Org Name:PEE DEE PATHOLOGY ASSOCIATES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-664-4300
Mailing Address - Street 1:PO BOX 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-554-9300
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:SUITE B210
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6064
Practice Address - Country:US
Practice Address - Phone:843-664-4314
Practice Address - Fax:843-664-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC480214Medicaid
SC480214Medicaid
SCCB3327Medicare PIN