Provider Demographics
NPI:1912206616
Name:JEFFERY M. REUBEN, MD PA
Entity Type:Organization
Organization Name:JEFFERY M. REUBEN, MD PA
Other - Org Name:SPINE INSTITUTE OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-379-7746
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-0670
Mailing Address - Country:US
Mailing Address - Phone:843-379-7746
Mailing Address - Fax:843-522-1275
Practice Address - Street 1:40 OKATIE CENTER BLVD S STE 350
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7511
Practice Address - Country:US
Practice Address - Phone:843-379-7746
Practice Address - Fax:843-522-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL30979207X00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1003009846OtherGROUP NPI
SCDE3412OtherMCAID DME
SCGP4760Medicaid
SC1003009846OtherGROUP NPI