Provider Demographics
NPI:1679761266
Name:SANTEE COOPER OB/GYN
Entity type:Organization
Organization Name:SANTEE COOPER OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-433-7262
Mailing Address - Street 1:402 NELSON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4058
Mailing Address - Country:US
Mailing Address - Phone:843-355-5401
Mailing Address - Fax:
Practice Address - Street 1:402 NELSON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4058
Practice Address - Country:US
Practice Address - Phone:843-355-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTEE COOPER OB/GYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN3221367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4314Medicaid