| Piave Pitisci Lake, M.d., Llc | |
|
409 Coleman Blvd Mt Pleasant SC 29464-4391 | |
| (843) 881-6616 | |
| (843) 881-7617 |
| Full Name | Piave Pitisci Lake, M.d., Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 409 Coleman Blvd, Mt Pleasant, South Carolina |
| Authorized Official Name and Position | Piave Pitisci Lake (OWNER) |
| Authorized Official Contact | 8438816616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Piave Pitisci Lake, M.d., Llc 409 Coleman Blvd Mt Pleasant SC 29464-4391 Ph: (843) 881-6616 | Piave Pitisci Lake, M.d., Llc 409 Coleman Blvd Mt Pleasant SC 29464-4391 Ph: (843) 881-6616 |
| NPI Number | 1518287523 |
|---|---|
| Provider Enumeration Date | 06/02/2010 |
| Last Update Date | 06/02/2010 |
| Medicare PECOS PAC ID | 4587856299 |
|---|---|
| Medicare Enrollment ID | O20101012001276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518287523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 22627 (South Carolina) | Primary |
| Provider Name | Piave Pitisci Lake |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316075203 PECOS PAC ID: 3678697281 Enrollment ID: I20100903000425 |
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