NPIMap

Organization Active NPI

Palmetto Moon Anesthesia, LLC

  • Anesthesiology Physician
  • Orangeburg, SC
National Provider Identifier
1477056794
Registry record updated Mar 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
3877 Issued in SC
Legal business name
PALMETTO MOON ANESTHESIA, LLC
Practice address
3045 St. Matthews Rd.
Orangeburg, SC 29118
Phone
(843) 861-3671
Fax
(803) 490-1571
NPI assigned
Mar 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2018

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

Authorized official

Name
Ms. Lindsey Anne Clark, CRNANPI 1407098411
Title
Employee/Member
Phone
(843) 861-3671

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)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 3877 SC Primary

Addresses

Primary practice location

3045 St. Matthews Rd.
Orangeburg, SC 29118

Mailing address

307 Winding Brook Dr
Cameron, SC 29030-8347
Phone (843) 861-3671

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1477056794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 WINDING BROOK DR",
            "city": "CAMERON",
            "state": "SC",
            "postal_code": "290308347",
            "telephone_number": "843-861-3671",
            "fax_number": "803-490-1571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 ST. MATTHEWS RD.",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29118",
            "telephone_number": "843-861-3671",
            "fax_number": "803-490-1571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO MOON ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "EMPLOYEE/MEMBER",
        "authorized_official_telephone_number": "843-861-3671",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "3877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; 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.