Medprimary LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

23088 Issued in SC

Legal business name

MEDPRIMARY LLC

Practice address

103B Harth PL
Summerville, SC 29485-8107

Phone

(843) 619-2990

NPI assigned

Jul 27, 2016

Organization subpart

No

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

Authorized official

Name

Maria V Gibson, MD, PHD, CPE, CEO

Title

Ceo

Phone

(843) 619-2990

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1932652856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 DEEP WATER DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103B HARTH PL",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858107",
            "telephone_number": "843-619-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPRIMARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-619-2990",
        "authorized_official_credential": "MD, PHD, CPE, CEO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "23088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Summerville, SC
• Providers in Summerville, 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 27, 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.