Provider Demographics
NPI:1720266810
Name:MOYD SURGICAL SERVICES
Entity Type:Organization
Organization Name:MOYD SURGICAL SERVICES
Other - Org Name:MOYD AND BANNISTER SURGICAL PARTNERSHIP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PICKENS
Authorized Official - Middle Name:KINARD
Authorized Official - Last Name:MOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:843-332-5111
Mailing Address - Street 1:528 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550
Mailing Address - Country:US
Mailing Address - Phone:843-332-5111
Mailing Address - Fax:843-383-8991
Practice Address - Street 1:528 E CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4312
Practice Address - Country:US
Practice Address - Phone:843-332-5111
Practice Address - Fax:843-383-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC040020Medicaid
SC040020Medicaid