Provider Demographics
NPI:1770746059
Name:THOMAS B. PACE MD LLC
Entity type:Organization
Organization Name:THOMAS B. PACE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-454-7484
Mailing Address - Street 1:PO BOX 27114
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-2114
Mailing Address - Country:US
Mailing Address - Phone:864-454-7484
Mailing Address - Fax:864-454-7497
Practice Address - Street 1:200 PATEWOOD DRIVE BLD C
Practice Address - Street 2:SUITE 275
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-7484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC68908Medicare UPIN