Provider Demographics
NPI:1235459900
Name:OPH MEDICAL, LLC
Entity Type:Organization
Organization Name:OPH MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:PIERRE
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-665-6170
Mailing Address - Street 1:4611 HARD SCRABBLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8584
Mailing Address - Country:US
Mailing Address - Phone:803-665-6170
Mailing Address - Fax:803-788-5823
Practice Address - Street 1:61 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7300
Practice Address - Country:US
Practice Address - Phone:803-665-6170
Practice Address - Fax:803-788-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC019338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty