NPIMap

Organization Active NPI

Tricia Etheridge, MD, PC

  • Family Medicine Physician
  • Ridgeland, SC
National Provider Identifier
1578620480
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19547 Issued in SC
Legal business name
TRICIA ETHERIDGE, MD, PC
Practice address
109 S Green St
Ridgeland, SC 29936-9165
Phone
(843) 726-6773
Fax
(843) 726-6778
NPI assigned
Jan 2, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Mrs. Tina Marie Murdaugh
Title
Office Manager
Phone
(843) 726-6773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19547 SC Primary

Addresses

Primary practice location

109 S Green St
Ridgeland, SC 29936-9165

Mailing address

PO Box 999
Ridgeland, SC 29936-2616
Phone (843) 726-6773

Other identifiers 4

IdentifierTypeStateIssuer
L25587MedicaidSC
42D1028556OtherSCCLIA
50017139OtherSCTAT
GP3946MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1578620480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 999",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299362616",
            "telephone_number": "843-726-6773",
            "fax_number": "843-726-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S GREEN ST",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299369165",
            "telephone_number": "843-726-6773",
            "fax_number": "843-726-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRICIA ETHERIDGE, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MURDAUGH",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "843-726-6773",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "19547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L25587",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "42D1028556",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAT",
            "identifier": "50017139",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3946",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.