Pendleton Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PENDLETON MEDICAL CLINIC

Practice address

220 E Main St
Pendleton, SC 29670-1308

Phone

(864) 646-3269

Fax

(864) 646-3511

NPI assigned

Jul 25, 2007

Last updated

Jul 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Herbert Press Cooper Jr., M.D.

Title

Owner

Phone

(864) 646-3269

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1902096191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 E MAIN ST",
            "city": "PENDLETON",
            "state": "SC",
            "postal_code": "296701308",
            "telephone_number": "864-646-3269",
            "fax_number": "864-646-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 E MAIN ST",
            "city": "PENDLETON",
            "state": "SC",
            "postal_code": "296701308",
            "telephone_number": "864-646-3269",
            "fax_number": "864-646-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "PRESS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-646-3269",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1690",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Pendleton, SC
• Providers in Pendleton, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.