Provider Demographics
NPI:1174509244
Name:DRS A MASON AHEARN & WRIGHT G SKINNER III
Entity Type:Organization
Organization Name:DRS A MASON AHEARN & WRIGHT G SKINNER III
Other - Org Name:BAY ORTHOPEDIC ASSOCIATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-527-4447
Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-1777
Mailing Address - Country:US
Mailing Address - Phone:843-527-4447
Mailing Address - Fax:843-527-6423
Practice Address - Street 1:1001 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2848
Practice Address - Country:US
Practice Address - Phone:843-527-4447
Practice Address - Fax:843-527-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAN56207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1447236815OtherNPI
SC1255317624OtherNPI
SC200042355OtherRAILROAD PROVIDER NUMBER
SC200042667OtherRAILROAD PROVIDER NUMBER
SCDM0379OtherMEDICAID DMERC
SCDM0379OtherMEDICAID DMERC
SC0524370001Medicare NSC
SC3673Medicare PIN
SC200042355OtherRAILROAD PROVIDER NUMBER