Organization
PEDIATRIC INNOVATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARC HUNTLEY SUDDARTH (PRESIDENT)
(803) 551-1113
Entity
Organization
Contact information
Practice address
1401 SAINT ANDREWS RD, SUITE 150, COLUMBIA, SC 29210-5930
(803) 551-1113
(803) 551-0905
Mailing address
1401 SAINT ANDREWS RD, SUITE 150, COLUMBIA, SC 29210-5930
(803) 551-1113
(803) 551-0905
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE1853
—
SC
Enumeration date
11/18/2005
Last updated
08/22/2020
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