Provider Demographics
NPI:1730121179
Name:PEDIATRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-432-1931
Mailing Address - Street 1:1346 HAILE ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3076
Mailing Address - Country:US
Mailing Address - Phone:803-432-1931
Mailing Address - Fax:803-432-1176
Practice Address - Street 1:1346 HAILE ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3076
Practice Address - Country:US
Practice Address - Phone:803-432-1931
Practice Address - Fax:803-432-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC134795Medicaid
SC299073Medicaid
SC320352Medicaid
SC85357Medicaid
SC95612Medicaid
SC75867Medicaid
SC185551Medicaid