Individual
AMANDA RAE LOOMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 E CHEVES ST, SUITE 480, FLORENCE, SC 29506-2650
(843) 777-7900
(843) 777-7925
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 777-7900
(843) 777-7925
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1946
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1745PA
—
SC
01
—
286371
MEDCOST
SC
01
—
8495247
CIGNA
SC
Enumeration date
06/12/2013
Last updated
12/01/2014
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