Provider Demographics
NPI:1457551533
Name:MOORE ORTHOPAEDIC CLINIC OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MOORE ORTHOPAEDIC CLINIC OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRESNAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-227-8080
Mailing Address - Street 1:104 SALUDA POINTE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-227-8080
Mailing Address - Fax:803-227-8081
Practice Address - Street 1:104 SALUDA POINTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7295
Practice Address - Country:US
Practice Address - Phone:803-227-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical