Active NPI
Pine Tree Family Practice, P. a.
- Family Medicine Physician
- Abbeville, SC
National Provider Identifier
1174720577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 8390
- Legal business name
- PINE TREE FAMILY PRACTICE, P. A.
- Practice address
- 901 W Greenwood St
Building 2
Abbeville, SC 29620-5678 - Phone
- (864) 366-9611
- Fax
- (864) 366-8521
- NPI assigned
- Jun 28, 2007
- Last updated
- Feb 21, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Bruce Samuel Johnston, M.D.
- Title
- Physician
- Phone
- (864) 366-9611
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8390 | SC | Primary |
Addresses
Primary practice location
901 W Greenwood St
Building 2
Abbeville, SC 29620-5678
Mailing address
PO Box 1126
Abbeville, SC 29620-1126
Phone (864) 366-9611
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080172913 | Other | SC | RAILROAD MEDICARE |
| PC0557 | Medicaid | SC |
National Provider Directory
National Provider DirectoryLocations
901 W Greenwood St
Ste 2
Abbeville, SC 29620
Phone (864) 366-9611
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Family Medicine Physician
- Abbeville, SC
- NPI 1164422770
-
- Family Medicine Physician
- Greenwood, SC
- NPI 1518992254
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1298246400000",
"number": "1174720577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1126",
"city": "ABBEVILLE",
"state": "SC",
"postal_code": "296201126",
"telephone_number": "864-366-9611",
"fax_number": "864-366-8521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 W GREENWOOD ST",
"address_2": "BUILDING 2",
"city": "ABBEVILLE",
"state": "SC",
"postal_code": "296205678",
"telephone_number": "864-366-9611",
"fax_number": "864-366-8521"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINE TREE FAMILY PRACTICE, P. A.",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-28",
"last_updated": "2011-02-21",
"status": "A",
"authorized_official_last_name": "JOHNSTON",
"authorized_official_first_name": "BRUCE",
"authorized_official_middle_name": "SAMUEL",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "864-366-9611",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "SC",
"license": "8390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080172913",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PC0557",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Abbeville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.