Providence Orthopedic Group, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

PROVIDENCE ORTHOPEDIC GROUP, LLC

Practice address

3 Richland Medical Park Dr
Suite 120
Columbia, SC 29203-6849

Phone

(803) 227-8000

Fax

(803) 227-8015

NPI assigned

Feb 26, 2014

Organization subpart

No

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

Authorized official

Name

Matt Frick

Title

Avp, Outpatient Services

Phone

(803) 227-8104

Specialties & licenses 1

Addresses

Other names 1

• Moore Center for Orthopedics Doing business as

Locations

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393372800000",
    "number": "1962827063",
    "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": "3 RICHLAND MEDICAL PARK DR",
            "address_2": "SUITE 120",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036849",
            "telephone_number": "803-227-8000",
            "fax_number": "803-227-8015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ORTHOPEDIC GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-26",
        "last_updated": "2014-02-26",
        "status": "A",
        "authorized_official_last_name": "FRICK",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "AVP, OUTPATIENT SERVICES",
        "authorized_official_telephone_number": "803-227-8104"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Center for Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Hospital, LLC
• Providence Occupational Health Services LLC
• Providence Orthopaedic Group LLC
• Providence Orthopaedic Group, LLC
• Providence Orthopedic Group, LLC
• Providence Pathology Associates PA
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC
• Providence Physician Practices LLC

• Orthopaedic Surgery Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Orthopaedic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.