Tri-County Surgery, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

TRI-COUNTY SURGERY, LLC

Practice address

3327 Casey St
Loris, SC 29569-2811

Phone

(843) 756-5524

NPI assigned

Jan 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lane Ingram Moore, M.D.NPI 1598723900

Title

Manager

Phone

(843) 756-5524

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Loris Surgical Associates, P.A. Former legal business name

Locations

Practitioners 1

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

• Lane Ingram Moore, M.D.

  • Surgery Physician
  • Myrtle Beach, SC
  • NPI 1598723900
  NPD (past) Authorized official

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720135254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3327 CASEY ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692811",
            "telephone_number": "843-756-5524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3327 CASEY ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692811",
            "telephone_number": "843-756-5524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LANE",
        "authorized_official_middle_name": "INGRAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "843-756-5524",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA1462",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902028",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loris Surgical Associates, P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Brian James Thacker, DO
• Mackenzie Jones Thompkins
• Madison Paige Thompson
• Shannon Smith Tiebout, DO
• Ashley Nicole Tiller, PA-C
• Twin States Helping Hands
• Nicole Vandzura
• Amy Elizabeth Wacha, BSN, RN
• Tommy L Waddell, PHARMACIST
• Summer Watts, FNP

• Surgery Physician in Loris, SC
• Providers in Loris, 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.