NPIMap

Organization Active NPI

Marion Medical Group PA

  • Rural Health Clinic/Center
  • Marion, SC
National Provider Identifier
1396779856
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MARION MEDICAL GROUP PA
Practice address
1115 N Main St
Marion, SC 29571-2025
Phone
(843) 423-0760
Fax
(843) 423-8138
NPI assigned
Jul 10, 2006
Last updated
Aug 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Authorized official

Name
Harold E Tucker
Title
Chief Executive Officer
Phone
(843) 431-2405

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1115 N Main St
Marion, SC 29571-2025

Mailing address

1115 N Main St
Marion, SC 29571-2025
Phone (843) 423-0760

Other identifiers 1

IdentifierTypeStateIssuer
RHC075MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1396779856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 N MAIN ST",
            "city": "MARION",
            "state": "SC",
            "postal_code": "295712025",
            "telephone_number": "843-423-0760",
            "fax_number": "843-423-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 N MAIN ST",
            "city": "MARION",
            "state": "SC",
            "postal_code": "295712025",
            "telephone_number": "843-423-0760",
            "fax_number": "843-423-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARION MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "843-431-2405"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC075",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.