Basic Information
| Provider Information | |||||||||
| NPI: | 1760483382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH CAROLINA INTERNAL MEDICINE ASSOCIATES AND REHABILITATION,L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7182 WOODROW ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037491111 | ||||||||
| FaxNumber: | 8037490050 | ||||||||
| Practice Location | |||||||||
| Address1: | 7182 WOODROW ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037491111 | ||||||||
| FaxNumber: | 8037490050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2005 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEVINSON | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGEING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8037491111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 11481 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207R00000X | 21980 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 11931 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 11871 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208100000X | 17388 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208600000X | 10531 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 363AM0700X | MPA 1942 TL | SC | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207R00000X | 11901 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1760483382 | 01 | SC | RAILROAD MEDICARE | OTHER | CI9660 | 01 | SC | RAILROAD MEDICARE | OTHER | GP2478 | 05 | SC | MEDICAID | 110188005 | 01 | SC | RAILROAD MEDICARE | OTHER |