Kingstree Surgical Associates

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

21490 Issued in SC

Legal business name

KINGSTREE SURGICAL ASSOCIATES

Practice address

135 N Academy St
Kingstree, SC 29556-3421

Phone

(803) 731-8393

NPI assigned

Oct 15, 2007

Organization subpart

No

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

Authorized official

Name

Blake H Moore, MD, FACS

Title

President

Phone

(843) 355-5462

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gilbertas Rimkus, MD

  • Surgery Physician
  • Conway, SC
  • NPI 1326126301
  NPD (past)

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1962691022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N ACADEMY ST",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295563421",
            "telephone_number": "803-731-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N ACADEMY ST",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295563421",
            "telephone_number": "803-731-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTREE SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-355-5462",
        "authorized_official_credential": "MD, FACS"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "SC",
            "license": "21490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "21490",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T56301",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meredith Kellahan
• Sharon King, LPN
• Kingstree Family Dentisry LLC
• Kingstree Family Medicine PA
• Kingstree Smiles
• Lake City Family Medicine
• Lake City Family Medicine, LLC
• Jennifer Moore Lamb, RN, BSN
• Karlie Michael Lambert, PTA
• Ariane U Lieberman, M.D.

• Surgery Physician in Kingstree, SC
• Providers in Kingstree, SC by specialty
• Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.