Provider Demographics
NPI:1821158122
Name:SC278 MEDICAL GROUP PA
Entity Type:Organization
Organization Name:SC278 MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CONDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-757-5966
Mailing Address - Street 1:PO BOX 3066
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-3066
Mailing Address - Country:US
Mailing Address - Phone:843-757-5966
Mailing Address - Fax:843-757-5996
Practice Address - Street 1:1714 TICKTON HALL RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7719
Practice Address - Country:US
Practice Address - Phone:843-726-2194
Practice Address - Fax:843-726-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15103207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty