Organization
PROVIDENCE ORTHOPAEDIC GROUP, LLC
Active
Other names
Moore Orthopaedic Clinic, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN MCNALLY (CEO)
(803) 227-8152
Entity
Organization
Contact information
Practice address
ONE WELLNESS BOULEVARD, SUITE 204, IRMO, SC 29063
(803) 227-8004
(803) 781-7334
Mailing address
PO BOX 843384, BOSTON, MA 02284-3384
(803) 227-8004
(803) 781-7338
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570521956
TAX ID#
SC
Enumeration date
07/28/2008
Last updated
04/26/2010
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