Basic Information
Provider Information | |||||||||
NPI: | 1316996499 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOINEAU | ||||||||
FirstName: | FRANKLIN | ||||||||
MiddleName: | GIRARD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 INDEPENDENCE PT | ||||||||
Address2: | SUITE 212 | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296154545 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8647976044 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 PATEWOOD DR | ||||||||
Address2: | SUITE A115 | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296153593 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8644545105 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/08/2006 | ||||||||
LastUpdateDate: | 07/24/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 5677 | SC | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 2080P0210X | 5677 | SC | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
ID | Type | State | Issuer | Description | 056770 | 05 | SC |   | MEDICAID | 1575217 | 01 | SC | CIGNA | OTHER | 57-6007863047 | 01 | SC | BLUE CHOICE OF SC | OTHER | 4258454 | 01 | SC | AETNA | OTHER | 57-6007863094 | 01 | SC | BCBS OF SC | OTHER |