Provider Demographics
NPI:1184501314
Name:SENIOR DOC SOUTH CAROLINA PC
Entity type:Organization
Organization Name:SENIOR DOC SOUTH CAROLINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-702-5145
Mailing Address - Street 1:5 HUTTON CENTRE DR STE 950
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8744
Mailing Address - Country:US
Mailing Address - Phone:855-434-7763
Mailing Address - Fax:
Practice Address - Street 1:700 NEXTON SQUARE DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7915
Practice Address - Country:US
Practice Address - Phone:855-434-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty