Provider Demographics
NPI:1912388646
Name:ZETA MEDICAL, LLC
Entity Type:Organization
Organization Name:ZETA MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-272-2220
Mailing Address - Street 1:616 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-9278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-9278
Practice Address - Country:US
Practice Address - Phone:803-272-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No302R00000XManaged Care OrganizationsHealth Maintenance Organization