NPIMap

Organization Active NPI

Providence Orthopaedic Group LLC

Doing business as Moore Orthopaedic Clinic

  • Orthopaedic Surgery Physician
  • Columbia, SC
National Provider Identifier
1255308342
Registry record updated Oct 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
570521956 Issued in SC
Legal business name
PROVIDENCE ORTHOPAEDIC GROUP LLC
Doing business as
Moore Orthopaedic Clinic
Practice address
14 Medical Park Rd
Suite 200
Columbia, SC 29203-6877
Phone
(803) 227-8152
Fax
(803) 227-8011
NPI assigned
Mar 7, 2006
Last updated
Oct 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2010

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

Authorized official

Name
Mr. Sean P. McNally
Title
Ceo
Phone
(803) 227-8152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 570521956 SC Primary

Addresses

Primary practice location

14 Medical Park Rd
Suite 200
Columbia, SC 29203-6877

Mailing address

PO Box 9592
Belfast, ME 04915-9592
Phone (803) 227-8152

Other identifiers 3

IdentifierTypeStateIssuer
DM0194OtherSCMEDICAID DME#
PA0686MedicaidSC
0497990001OtherSCMEDICARE DME#

Other names 1

  • Moore Orthopaedic Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Moore Orthopaedic Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

7035 Saint Andrews Rd
Ste 4
Columbia, SC 29212
Phone (803) 781-9187

731 Fashion Dr
Columbia, SC 29229
Phone (803) 227-8005

Practitioners & affiliated clinicians

Practitioners 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287705600000",
    "number": "1255308342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9592",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049159592",
            "telephone_number": "803-227-8152",
            "fax_number": "803-227-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK RD",
            "address_2": "SUITE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036877",
            "telephone_number": "803-227-8152",
            "fax_number": "803-227-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ORTHOPAEDIC GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2010-10-22",
        "status": "A",
        "authorized_official_last_name": "MCNALLY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-227-8152",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "SC",
            "license": "570521956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME#",
            "identifier": "DM0194",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA0686",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME#",
            "identifier": "0497990001",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Orthopaedic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.