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PROVIDENCE ORTHOPAEDIC GROUP NPI 1285674572


NPI Information

NPI: 1285674572
Provider Name: PROVIDENCE ORTHOPAEDIC GROUP

Doing Business As: MOORE ORTHOPAEDIC CLINIC

Classification: Orthopaedic Surgery - 207X00000X
Entity Type: Organization
Address:
4721 SUNSET BLVD
SUITE A
LEXINGTON, SC
ZIP 29072
Phone: (803) 227-8007
Get Directions

PROVIDENCE ORTHOPAEDIC GROUP is an orthopaedic surgery in Lexington, SC. The provider is an orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. PROVIDENCE ORTHOPAEDIC GROUP NPI is 1285674572. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Moore Orthopaedic Clinic.

The provider's business location address is:

4721 SUNSET BLVD
SUITE A
LEXINGTON, SC
ZIP 29072-151
Phone: (803) 227-8007
Fax: (803) 996-3180

The provider's authorized official is Sean Mcnally .
The authorized official title is Ceo and has the following contact phone number (803) 227-8152.

The enumeration date for this NPI number is 6/7/2006 and was last updated on 6/29/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207X00000XOrthopaedic Surgery570521956SOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1PA0686MEDICAIDSOUTH CAROLINA
21314MEDICARE PINSOUTH CAROLINA
314979900001OTHERSOUTH CAROLINAMEDICARE DME#
4DM0194OTHERSOUTH CAROLINAMEDICAID DME#
5570521956-009OTHERSOUTH CAROLINABC/BS PROVIDER #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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