Mol Ky, DO
Individual provider Active NPI General Practice Physician · Fairfax, SC
NPI 1063607646 · NPPES record last updated Sep 7, 2007
Key facts
- NPI
- 1063607646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- MD01101TL (SC)
- Practice address
- 333 Revolutionary Trail
Fairfax, SC 29827 - Phone
- (803) 632-2533
- NPI assigned
- Sep 7, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Philadelphia College of Osteopathic Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Novant Health Urgent Cares LLC
Practice addresses (Care Compare)
2174 Cherry Rd
Rock Hill, SC 29732-2160
Phone (803) 325-8280
Hospital & facility affiliations
- Piedmont Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071015000370 | SC | Practitioner - Family Practice |
4082700505 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD01101TL | SC | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Novant Health Urgent Cares LLC | Current |
Accepting new patients |
Locations
6167 Braided Mane Pass SW
Aiken, SC 29803
Phone (803) 502-1484
100 Jimmy Love Ln
Columbia, SC 29212
Phone (803) 731-4055
2174 Cherry Rd
Rock Hill, SC 29732
Phone (803) 325-8280
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | MD01101TL | SC | Yes |
Addresses
Primary practice location
333 Revolutionary Trail
Fairfax, SC 29827
Mailing address
PO Box 990
333 Revolutionary Trail
Fairfax, SC 29827
Phone (803) 632-2533
Other providers in Fairfax, SC
- Azalyn Hickman
- Honest Way Transportation LLC
- Charles Taylor Hudson
- Robert M Jones
- Walter R Kirby
- Vicki Lynn Landis
- Low Country Health Care System, Inc
- Shenika L. Marshall-Hill
- Janet M McKissick
- Baxter McLendon
All providers in Fairfax, SC · General Practice Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.