Provider Demographics
NPI:1356531271
Name:CENTER OF OBSTETRICS AND GYNECOLOGY L.L.C.
Entity type:Organization
Organization Name:CENTER OF OBSTETRICS AND GYNECOLOGY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:GAGNE
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-347-7333
Mailing Address - Street 1:8024 MYRTLE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8945
Mailing Address - Country:US
Mailing Address - Phone:843-347-7333
Mailing Address - Fax:843-347-7288
Practice Address - Street 1:8024 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-347-7333
Practice Address - Fax:843-347-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT28725Medicaid
NC790628Medicaid
SCT28725Medicaid
F856540281Medicare PIN