NPIMap

Organization Active NPI

South Carolina Center for Intergrative Medicine

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1669981429
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2504 Issued in SC
Legal business name
SOUTH CAROLINA CENTER FOR INTERGRATIVE MEDICINE
Practice address
612 St Andrews Rd.
Ste 2
Columbia, SC 29210-2921
Phone
(803) 386-8684
Fax
(803) 386-8684
NPI assigned
Sep 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Kimberly Shirk, PACNPI 1164683926
Title
Physcian Assistant
Phone
(803) 386-8684

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 2504 SC Primary

Addresses

Primary practice location

612 St Andrews Rd.
Ste 2
Columbia, SC 29210-2921

Mailing address

612 Saint Andrews Rd Ste 2
Columbia, SC 29210-5120
Phone (803) 386-8684

Other identifiers 1

IdentifierTypeStateIssuer
1164683926OtherSCCOMMERCIAL

Other names 1

  • South Carolina Center for Intergrative Medicine Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2158713South Carolina Center for Integrative Medicine612 St Andrews Road, Columbia, SC 29210Certificate of waiverDec 4, 2026

National Provider Directory

National Provider Directory

Locations

612 Saint Andrews Rd
Ste 3
Columbia, SC 29210
Phone (803) 772-7626

234 Outlet Pointe Blvd
Columbia, SC 29210

612 Saint Andrews Rd
Ste 2
Columbia, SC 29210
Phone (803) 386-8684

Practitioners & affiliated clinicians

Practitioners 12

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": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1669981429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 SAINT ANDREWS RD STE 2",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292105120",
            "telephone_number": "803-386-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 ST ANDREWS RD.",
            "address_2": "STE 2",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292102921",
            "telephone_number": "803-386-8684",
            "fax_number": "803-386-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA CENTER FOR INTERGRATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-25",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SHIRK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PHYSCIAN ASSISTANT",
        "authorized_official_telephone_number": "803-386-8684",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "2504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "1164683926",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Carolina Center for Intergrative Medicine",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.