Provider Demographics
NPI:1700882388
Name:ALLERGY ASTHMA SINUS CTR
Entity Type:Organization
Organization Name:ALLERGY ASTHMA SINUS CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-679-9335
Mailing Address - Street 1:800 E CHEVES ST
Mailing Address - Street 2:STE 420
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2649
Mailing Address - Country:US
Mailing Address - Phone:843-679-9335
Mailing Address - Fax:843-679-9294
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:STE 420
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2649
Practice Address - Country:US
Practice Address - Phone:843-679-9335
Practice Address - Fax:843-679-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15976207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC159768Medicaid
SC159768Medicaid
5324Medicare PIN
5321Medicare PIN