Provider Demographics
NPI:1982644290
Name:PINNER CLINIC PA
Entity Type:Organization
Organization Name:PINNER CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINNER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-945-7475
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:PEAK
Mailing Address - State:SC
Mailing Address - Zip Code:29122-0099
Mailing Address - Country:US
Mailing Address - Phone:803-945-7475
Mailing Address - Fax:803-345-2832
Practice Address - Street 1:32 RIVER ST
Practice Address - Street 2:
Practice Address - City:PEAK
Practice Address - State:SC
Practice Address - Zip Code:29122-0099
Practice Address - Country:US
Practice Address - Phone:803-945-7475
Practice Address - Fax:803-345-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6376207Q00000X, 207Q00000X
SCA26595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0659Medicaid
SCPA0659Medicaid
SC1612Medicare ID - Type Unspecified