Lakeside Orthopaedic Center, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

27593 Issued in SC

Legal business name

LAKESIDE ORTHOPAEDIC CENTER, LLC

Practice address

50 E Hospital St
Suite 6
Manning, SC 29102-3149

Phone

(803) 433-5633

Fax

(803) 433-5636

NPI assigned

Dec 22, 2005

Organization subpart

No

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

Authorized official

Name

David Woodbury, MD

Title

Owner

Phone

(803) 433-5633

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1528044468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E HOSPITAL ST",
            "address_2": "SUITE 6",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-433-5633",
            "fax_number": "803-433-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E HOSPITAL ST",
            "address_2": "SUITE 6",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023149",
            "telephone_number": "803-433-5633",
            "fax_number": "803-433-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ORTHOPAEDIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2012-07-27",
        "status": "A",
        "authorized_official_last_name": "WOODBURY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-433-5633",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "SC",
            "license": "27593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275936",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4233",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Manning, SC
• Providers in Manning, 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 Jul 27, 2012; 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.