Provider Demographics
NPI:1013969245
Name:KEARSE, JAMES C III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:KEARSE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:SENTINEL HEALTH PARTNERS PA
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-1259
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:710 DEWITT DR
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9069
Practice Address - Country:US
Practice Address - Phone:803-438-7566
Practice Address - Fax:803-438-4371
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC115100Medicaid
SC080100775OtherRAILROAD MEDICARE PIN
26259OtherMEDCOST PIN
SC115100Medicaid
D17864Medicare UPIN