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Organization
PROVIDENCE ORTHOPEDIC GROUP, LLC
Active
Organization
PROVIDENCE ORTHOPEDIC GROUP, LLC
Active
Other names
Moore Center for Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT FRICK (AVP, OUTPATIENT OPERATIONS)
(803) 227-8104
Entity
Organization
Contact information
Practice address
120 GATEWAY CORPORATE BLVD, COLUMBIA, SC 29203-9611
(803) 227-8000
Mailing address
104 SALUDA POINTE DR, LEXINGTON, SC 29072-7295
(803) 227-8000
(803) 227-8015
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
SC
Other
Enumeration date
01/30/2014
Last updated
01/30/2014
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