Organization Active NPI

Georgetown Radiation Therapy Center

  • Radiation Oncology Physician
  • Georgetown, SC
National Provider Identifier
1053304675
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
GEORGETOWN RADIATION THERAPY CENTER
Practice address
2405 N Fraser St
Georgetown, SC 29440-6410
Phone
(843) 545-5600
NPI assigned
Aug 30, 2005
Last updated
Nov 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Authorized official

Name
Elizabeth Ward
Title
Executive Vice President/Chief Fina
Phone
(843) 527-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X Primary

Addresses

Primary practice location

2405 N Fraser St
Georgetown, SC 29440-6410

Mailing address

PO Drawer 1718
Georgetown, SC 29442-1718

Other identifiers 1

IdentifierTypeStateIssuer
EA212264MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000373 SC Part B Supplier - Radiation Therapy Center 3678473477 Receives reassigned benefits from 14 practitioners
Practice locations: Murrells Inlet, SC

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4033 Highway 17
Unit 106
Murrells Inlt, SC 29576
Phone (843) 545-5600

9568 Kings Charter Dr
Ashland, VA 23005

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1053304675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO DRAWER 1718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294421718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294406410",
            "telephone_number": "843-545-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN RADIATION THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2018-11-05",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT/CHIEF FINA",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EA212264",
            "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 Nov 5, 2018; 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.