NPIMap

Organization Active NPI

Palmetto Pediatrics of Conway

  • Specialist
  • Conway, SC
National Provider Identifier
1962481531
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
22576 Issued in SC
Legal business name
PALMETTO PEDIATRICS OF CONWAY
Practice address
171 Waccamaw Medical Park CT
Conway, SC 29526-8965
Phone
(843) 234-5678
Fax
(843) 234-4567
NPI assigned
Jan 12, 2006
Last updated
Jan 27, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

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

Authorized official

Name
Dr. Brian M Rabon, MDNPI 1619965027
Title
MD
Phone
(843) 234-5678

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 22576 SC Primary

Addresses

Primary practice location

171 Waccamaw Medical Park CT
Conway, SC 29526-8965

Mailing address

171 Waccamaw Medical Park CT
Conway, SC 29526-8965
Phone (843) 234-5678

Other identifiers 1

IdentifierTypeStateIssuer
GP4121MedicaidSC

National Provider Directory

National Provider Directory

Locations

140 Professional Park Dr
Conway, SC 29526
Phone (843) 234-5678

171 Waccamaw Medical Park Ct
Conway, SC 29526
Phone (843) 234-5678

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1962481531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 WACCAMAW MEDICAL PARK CT",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268965",
            "telephone_number": "843-234-5678",
            "fax_number": "843-234-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 WACCAMAW MEDICAL PARK CT",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268965",
            "telephone_number": "843-234-5678",
            "fax_number": "843-234-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO PEDIATRICS OF CONWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "RABON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "843-234-5678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "22576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4121",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; 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.