Moncks Corner Pediatrics LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

MONCKS CORNER PEDIATRICS LLC

Practice address

5000 Epson Plantation Dr
Suite B
Moncks Corner, SC 29461-3979

Phone

(843) 761-2000

Fax

(843) 761-2267

NPI assigned

Jul 17, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Joseph R West Jr., M.D.NPI 1861503146

Title

Owner

Phone

(843) 761-2000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph West, MD

  • Pediatrics Physician
  • Powdersville, SC
  • NPI 1861503146
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276041600000",
    "number": "1003070103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 EPSON PLANTATION DR",
            "address_2": "SUITE B",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613979",
            "telephone_number": "843-761-2000",
            "fax_number": "843-761-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 EPSON PLANTATION DR",
            "address_2": "SUITE B",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613979",
            "telephone_number": "843-761-2000",
            "fax_number": "843-761-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONCKS CORNER PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-17",
        "last_updated": "2010-06-09",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-761-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Enderia Nykisha Mitchell, RN
• Wyatt Mitchell, LMSW
• Janice Mitchum
• Lauren Mitchum
• Moncks Corner Dental Group, PC
• Moncks Corner Pediatrics LLC
• Moncks Corner Physical Therapy, LLC
• Laquawn J Montgomery
• Joseph Carlisle Moore Jr., M.D.
• Kathleen Bailey Moore, RN, BSN

• Rural Health Clinic/Center in Moncks Corner, SC
• Providers in Moncks Corner, SC by specialty
• Rural Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.