Tidewater Surgical Group, PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G93021 Issued in SC

Legal business name

TIDEWATER SURGICAL GROUP, PA

Practice address

2831B Tricom St
North Charleston, SC 29406-9172

Phone

(843) 797-8880

Fax

(843) 797-8884

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Lorraine Veronica Tyler

Title

Practice Administraot

Phone

(843) 797-8880

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• John Lee Smear, M.D.

  • Surgery Physician
  • North Charleston, SC
  • NPI 1467522599
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598835639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2831B TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "843-797-8880",
            "fax_number": "843-797-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831B TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "843-797-8880",
            "fax_number": "843-797-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER SURGICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_middle_name": "VERONICA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRAOT",
        "authorized_official_telephone_number": "843-797-8880",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "SC",
            "license": "G93021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4370",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca M Thomasson, R.O.T./L
• Ashley Nicole Thompson
• Candice Thompson
• Tammy Laurell Thompson, RN
• Tidelands Rehabilitation Group LLC
• Chris Leo Tierney, DC
• Lynsey Bryce Tiller
• Deeana Lane Tilman, FNP-BC
• Terri Timmerman
• Matthew Tindall, DO

• Surgery Physician in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.