Organization
PROVIDENCE ORTHOPAEDIC GROUP LLC
Active
Other names
Moore Orthopaedic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN MCNALLY OT (CEO)
(803) 227-8152
Entity
Organization
Contact information
Practice address
104 SALUDA POINTE DRIVE, LEXINGTON, SC 29072
(803) 227-8000
Mailing address
PO BOX 9592, BELFAST, ME 04915-9592
(803) 227-8000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA0686
—
SC
Enumeration date
09/11/2007
Last updated
10/22/2010
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