NPIMap

Organization Active NPI

South Coast Gastroenterology

  • Gastroenterology Physician
  • N Charleston, SC
National Provider Identifier
1811296239
Registry record updated Mar 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
331 Issued in SC
Legal business name
SOUTH COAST GASTROENTEROLOGY
Practice address
2891 Tricom St Ste B
N Charleston, SC 29406-7110
Phone
(843) 718-2676
Fax
(843) 718-2675
NPI assigned
Mar 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2016

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

Authorized official

Name
Polly B Price
Title
Billing Administrator
Phone
(843) 669-5162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 331 SC Primary

Addresses

Primary practice location

2891 Tricom St Ste B
N Charleston, SC 29406-7110

Mailing address

PO Box 100523
Florence, SC 29502-0523
Phone (843) 669-5162

Other identifiers 1

IdentifierTypeStateIssuer
GP5658MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1811296239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100523",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295020523",
            "telephone_number": "843-669-5162",
            "fax_number": "843-667-4573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 TRICOM ST STE B",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294067110",
            "telephone_number": "843-718-2676",
            "fax_number": "843-718-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-24",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "843-669-5162"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5658",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in N Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.