Providence Orthopedic Group, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

PROVIDENCE ORTHOPEDIC GROUP, LLC

Doing business as

Moore Center for Orthopedics

Practice address

7936 Broad River Rd
Irmo, SC 29063-2355

Phone

(803) 227-8000

Fax

(803) 227-8015

NPI assigned

Feb 3, 2014

Last updated

Feb 3, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Matt Frick

Title

Avp, Outpatient Services

Phone

(803) 227-8104

Specialties & licenses 1

Addresses

Other names 1

• Moore Center for Orthopedics Doing business as

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

{
    "created_epoch": "1391385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1467875054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 SALUDA POINTE DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290727295",
            "telephone_number": "803-227-8000",
            "fax_number": "803-227-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7936 BROAD RIVER RD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632355",
            "telephone_number": "803-227-8000",
            "fax_number": "803-227-8015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ORTHOPEDIC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-03",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "FRICK",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "AVP, OUTPATIENT SERVICES",
        "authorized_official_telephone_number": "803-227-8104",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Center for Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kathleen Purcell-Cannon, O.D.
• Shaienna Quinn, LMSW, LCSW-A

• Orthopaedic Surgery Physician in Irmo, SC
• Providers in Irmo, SC by specialty
• Orthopaedic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.