Provider Demographics
NPI:1821055252
Name:SEASONS OB-GYN LLC
Entity Type:Organization
Organization Name:SEASONS OB-GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COUNSELOR / CPC
Authorized Official - Prefix:MS
Authorized Official - First Name:TAFFY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-569-2900
Mailing Address - Street 1:9279 MEDICAL PLAZA DR STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9141
Mailing Address - Country:US
Mailing Address - Phone:843-569-2900
Mailing Address - Fax:843-569-7752
Practice Address - Street 1:9279 MEDICAL PLAZA DR STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9141
Practice Address - Country:US
Practice Address - Phone:843-569-2900
Practice Address - Fax:843-569-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2041Medicaid
SC5918Medicare UPIN