Provider Demographics
NPI:1194853168
Name:JOHN C. MACILWAINE, M.D., LLC
Entity Type:Organization
Organization Name:JOHN C. MACILWAINE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACILWAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-769-9450
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5736
Mailing Address - Country:US
Mailing Address - Phone:843-769-9450
Mailing Address - Fax:843-769-9451
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 280
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-769-9450
Practice Address - Fax:843-769-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29539207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC295399Medicaid