Provider Demographics
NPI:1972782084
Name:COLUMBIA ALLERGY CLINIC
Entity Type:Organization
Organization Name:COLUMBIA ALLERGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-799-4628
Mailing Address - Street 1:2601 LAUREL ST
Mailing Address - Street 2:#230
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2033
Mailing Address - Country:US
Mailing Address - Phone:803-799-4628
Mailing Address - Fax:803-765-2687
Practice Address - Street 1:2601 LAUREL ST
Practice Address - Street 2:#230
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2033
Practice Address - Country:US
Practice Address - Phone:803-799-4628
Practice Address - Fax:803-765-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10147207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2114Medicare PIN