Provider Demographics
NPI:1538149802
Name:SC OB-GYN ASSOCIATES PA
Entity type:Organization
Organization Name:SC OB-GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CHE,CMPE
Authorized Official - Phone:803-254-9225
Mailing Address - Street 1:1301 TAYLOR ST
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2942
Mailing Address - Country:US
Mailing Address - Phone:803-254-9225
Mailing Address - Fax:803-771-7597
Practice Address - Street 1:1301 TAYLOR ST
Practice Address - Street 2:SUITE 2L
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2942
Practice Address - Country:US
Practice Address - Phone:803-254-9225
Practice Address - Fax:803-771-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1294Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER