Provider Demographics
NPI:1447202536
Name:SOUTH CAROLINA INPATIENT MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SOUTH CAROLINA INPATIENT MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALBOT
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:678-441-8500
Mailing Address - Street 1:PO BOX 96368
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-6368
Mailing Address - Country:US
Mailing Address - Phone:678-441-8500
Mailing Address - Fax:678-441-8646
Practice Address - Street 1:200 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2022
Practice Address - Country:US
Practice Address - Phone:678-441-8500
Practice Address - Fax:675-441-8656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HOSPITAL PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4053Medicaid
SC1447202536OtherBCBS
SCDD0096OtherRR MEDICARE
SCDD0096OtherRR MEDICARE