Provider Demographics
NPI:1215323969
Name:INJURY MEDICAL CENTERS OF SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:INJURY MEDICAL CENTERS OF SOUTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATTEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-786-0559
Mailing Address - Street 1:208 SHALLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8110
Mailing Address - Country:US
Mailing Address - Phone:434-444-2705
Mailing Address - Fax:
Practice Address - Street 1:208 SHALLOW BROOK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8110
Practice Address - Country:US
Practice Address - Phone:434-444-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
SC31618207Q00000X
SC2604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty