NPIMap

Organization Active NPI

Edisto Regional Health Services

  • Pediatrics Physician
  • Orangeburg, SC
National Provider Identifier
1982650107
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
EDISTO REGIONAL HEALTH SERVICES
Practice address
2850 Pelham CT
Orangeburg, SC 29118-1400
Phone
(803) 531-8500
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Thomas Dandridge
Title
President
Phone
(803) 395-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2850 Pelham CT
Orangeburg, SC 29118-1400

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4499

Other identifiers 1

IdentifierTypeStateIssuer
GP4354MedicaidSC

Other names 1

  • Edisto Regional Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Low Country Pain Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982650107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4499",
            "fax_number": "803-536-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 PELHAM CT",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291181400",
            "telephone_number": "803-531-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO REGIONAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANDRIDGE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-395-2200"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4354",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edisto Regional Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.