Provider Demographics
NPI:1811081748
Name:WAYNE B SRIBNICK MD
Entity type:Organization
Organization Name:WAYNE B SRIBNICK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FREDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-254-2786
Mailing Address - Street 1:2701 MIDDLEBURG DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2405
Mailing Address - Country:US
Mailing Address - Phone:803-254-2786
Mailing Address - Fax:803-254-9015
Practice Address - Street 1:2701 MIDDLEBURG DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2405
Practice Address - Country:US
Practice Address - Phone:803-254-2786
Practice Address - Fax:803-254-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC112531Medicaid
SC112531Medicaid