Providence Orthopaedic Group, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

PROVIDENCE ORTHOPAEDIC GROUP, LLC

Practice address

One Wellness Boulevard
Suite 204
Irmo, SC 29063

Phone

(803) 227-8004

Fax

(803) 781-7334

NPI assigned

Jul 28, 2008

Organization subpart

No

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

Authorized official

Name

Sean McNally

Title

Ceo

Phone

(803) 227-8152

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Moore Orthopaedic Clinic, P.A. Doing business as

Tax ID family

Moore Center for Orthopedics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Orthopedic Group, LLC

  • Orthopaedic Surgery Physician
  • Lexington, SC
  • NPI 1831513324
  NPD tax ID

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272240000000",
    "number": "1033374244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843384",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022843384",
            "telephone_number": "803-227-8004",
            "fax_number": "803-781-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE WELLNESS BOULEVARD",
            "address_2": "SUITE 204",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "29063",
            "telephone_number": "803-227-8004",
            "fax_number": "803-781-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ORTHOPAEDIC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-28",
        "last_updated": "2010-04-26",
        "status": "A",
        "authorized_official_last_name": "MCNALLY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-227-8152"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "570521956",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Orthopaedic Clinic, P.A.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Precious Jewels Medical & Health Services, LLC
• Precious Jewels Medical Lab
• Tena Pressley
• Progressive Chiropractic & Orthopedic
• Progressive Physical Therapy, PA
• Providence Orthopedic Group, LLC
• Providence Physician Practices LLC
• Pruitthealth Therapy Services, Inc.
• Publix Super Markets Inc
• Kathleen Purcell-Cannon, O.D.

• Orthopaedic Surgery Physician in Irmo, SC
• Providers in Irmo, SC by specialty
• Orthopaedic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2010; 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.