NPIMap

Organization Active NPI

Georgetown Pediatric Center

  • Rural Health Clinic/Center
  • Georgetown, SC
National Provider Identifier
1013334200
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GEORGETOWN PEDIATRIC CENTER
Practice address
57 Jessamine Ave
Georgetown, SC 29440-5837
Phone
(843) 546-8686
Fax
(843) 546-1353
NPI assigned
Mar 25, 2014
Last updated
Mar 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Authorized official

Name
Lee Ann Amann, MHA
Title
Adminstrator
Phone
(843) 546-8686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

57 Jessamine Ave
Georgetown, SC 29440-5837

Mailing address

PO Box 618
Georgetown, SC 29442-0618
Phone (843) 546-8686

Other identifiers 1

IdentifierTypeStateIssuer
Q84256MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1013334200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 618",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294420618",
            "telephone_number": "843-546-8686",
            "fax_number": "843-546-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 JESSAMINE AVE",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294405837",
            "telephone_number": "843-546-8686",
            "fax_number": "843-546-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN PEDIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "AMANN",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "843-546-8686",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q84256",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.