Provider Demographics
NPI:1013976505
Name:PEDIATRIC ENDOCRINE SPECIALTY
Entity type:Organization
Organization Name:PEDIATRIC ENDOCRINE SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIZE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:803-865-6008
Mailing Address - Street 1:3000 NE MEDICAL PARK
Mailing Address - Street 2:SUITE 212
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6251
Mailing Address - Country:US
Mailing Address - Phone:803-865-6008
Mailing Address - Fax:803-865-6018
Practice Address - Street 1:3000 NE MEDICAL PARK
Practice Address - Street 2:SUITE 212
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6251
Practice Address - Country:US
Practice Address - Phone:803-865-6008
Practice Address - Fax:803-865-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19871261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3583Medicaid
SC19871OtherDR. HEIZE'S SC MED LIC #
SCGP3583Medicaid
SCGP3583Medicaid