Provider Demographics
NPI:1013295740
Name:ACA LABORATORIES
Entity type:Organization
Organization Name:ACA LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:ZIVKO
Authorized Official - Last Name:PITOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-747-4294
Mailing Address - Street 1:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-1726
Mailing Address - Country:US
Mailing Address - Phone:843-747-4294
Mailing Address - Fax:
Practice Address - Street 1:113 ETIWAN DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3073
Practice Address - Country:US
Practice Address - Phone:843-747-4294
Practice Address - Fax:843-747-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42D2043357291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory