Provider Demographics
NPI:1851464457
Name:THE INSTITUTE FOR NEURODEVELOPMENTAL PEDIATRICS, LLC
Entity Type:Organization
Organization Name:THE INSTITUTE FOR NEURODEVELOPMENTAL PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-777-5770
Mailing Address - Street 1:305 E CHEVES ST
Mailing Address - Street 2:MCLEOD MEDICAL PARK WEST, SUITE 330
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2610
Mailing Address - Country:US
Mailing Address - Phone:843-777-5770
Mailing Address - Fax:843-777-5772
Practice Address - Street 1:305 E CHEVES ST
Practice Address - Street 2:MCLEOD MEDICAL PARK WEST, SUITE 330
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2610
Practice Address - Country:US
Practice Address - Phone:843-777-5770
Practice Address - Fax:843-777-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC121142080P0006X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
Not Answered2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC121148Medicaid