Provider Demographics
NPI:1003009846
Name:JEFFERY M REUBEN, MD PA
Entity Type:Organization
Organization Name:JEFFERY M REUBEN, MD PA
Other - Org Name:SPINE INSTITUTE OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-379-7746
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-0670
Mailing Address - Country:US
Mailing Address - Phone:843-379-7746
Mailing Address - Fax:
Practice Address - Street 1:40 OKATIE CTR BLVD STE 205
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7511
Practice Address - Country:US
Practice Address - Phone:843-379-7746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3412OtherMEDICAID DME
SCGP4760Medicaid
SCGP4760Medicaid
5573840001Medicare NSC