NPIMap

Organization Active NPI

Providence Orthopedic Group, LLC

  • Orthopaedic Surgery Physician
  • Columbia, SC
National Provider Identifier
1811310576
Registry record updated Jan 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PROVIDENCE ORTHOPEDIC GROUP, LLC
Practice address
120 Gateway Corporate Blvd
Columbia, SC 29203-9611
Phone
(803) 227-8000
NPI assigned
Jan 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2014

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

Authorized official

Name
Mr. Matt Frick
Title
Avp, Outpatient Operations
Phone
(803) 227-8104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X SC Primary

Addresses

Primary practice location

120 Gateway Corporate Blvd
Columbia, SC 29203-9611

Mailing address

104 Saluda Pointe Dr
Lexington, SC 29072-7295
Phone (803) 227-8000

Other names 1

  • Moore Center for Orthopedics Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1811310576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 SALUDA POINTE DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290727295",
            "telephone_number": "803-227-8000",
            "fax_number": "803-227-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GATEWAY CORPORATE BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039611",
            "telephone_number": "803-227-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ORTHOPEDIC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "FRICK",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "AVP, OUTPATIENT OPERATIONS",
        "authorized_official_telephone_number": "803-227-8104",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Center for Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 30, 2014; 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.