Provider Demographics
NPI:1457342370
Name:RIVES, THOMAS SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:RIVES
Suffix:
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 1:4237 RIVER HILLS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6444
Mailing Address - Country:US
Mailing Address - Phone:843-777-7000
Mailing Address - Fax:843-777-7005
Practice Address - Street 1:4237 RIVER HILLS DR STE 130
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6444
Practice Address - Country:US
Practice Address - Phone:843-777-7000
Practice Address - Fax:843-777-7005
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15069208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC150696Medicaid
SC150696Medicaid
SCC894449223Medicare PIN