Basic Information
| Provider Information | |||||||||
| NPI: | 1497816672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEE DEE OBGYN ASSOC., PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 EAST HWY 76 | ||||||||
| Address2: | MEDICAL PARK 2 SUITE 2 | ||||||||
| City: | MULLINS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295746037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434312740 | ||||||||
| FaxNumber: | 8434312197 | ||||||||
| Practice Location | |||||||||
| Address1: | 2845 E HIGHWAY 76 | ||||||||
| Address2: | MEDICAL PARK 2 SUITE 2 | ||||||||
| City: | MULLINS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295746037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434312740 | ||||||||
| FaxNumber: | 8434312197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MURRAY | ||||||||
| AuthorizedOfficialFirstName: | ERNEST | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8434312740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 8727 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 9630895 | 01 | SC | UNITED HEALTHCARE | OTHER | 02375 | 01 | NC | OFFICE IDENTIFIER | OTHER | PA1872 | 05 | SC | MEDICAID | 20000382 | 01 | SC | SELECT HEALTH | OTHER | 8902375 | 01 | NC | OFFICE IDENTIFIER | OTHER |