Basic Information
| Provider Information | |||||||||
| NPI: | 1346200409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHMOND | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | STE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976306 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10630 CLEMSON BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296784546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644826000 | ||||||||
| FaxNumber: | 8644827166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 21297 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200034658 | 01 | SC | RR MEDICARE | OTHER | T51128 | 05 | SC | MEDICAID |