Organization Active NPI

Physician Management Services of Eastern South Carolina, LLC

  • Family Medicine Physician
  • Greer, SC
National Provider Identifier
1962933119
Registry record updated Mar 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14366 Issued in SC
Legal business name
PHYSICIAN MANAGEMENT SERVICES OF EASTERN SOUTH CAROLINA, LLC
Practice address
841 S Buncombe Rd
Greer, SC 29650-2401
Phone
(888) 829-8550
NPI assigned
Mar 21, 2017
Last updated
Mar 21, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
VAXCARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 21, 2017

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

Authorized official

Name
Brett Kenefick
Title
President
Phone
(888) 829-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 14366 SC Primary

Addresses

Primary practice location

841 S Buncombe Rd
Greer, SC 29650-2401

Mailing address

3113 Lawton Rd
Suite 250
Orlando, FL 32803-3531
Phone (888) 829-8550

Other identifiers 1

IdentifierTypeStateIssuer
PHC059OtherMEDICARE PTAN

National Provider Directory

National Provider Directory
Part of
Vaxcare Corporation

Practitioners & affiliated clinicians

Practitioners 1

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": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490054400000",
    "number": "1962933119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3113 LAWTON RD",
            "address_2": "SUITE 250",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328033531",
            "telephone_number": "888-829-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 S BUNCOMBE RD",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296502401",
            "telephone_number": "888-829-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN MANAGEMENT SERVICES OF EASTERN SOUTH CAROLINA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAXCARE CORPORATION",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-03-21",
        "status": "A",
        "authorized_official_last_name": "KENEFICK",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-829-8550"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "14366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "PHC059",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; 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.