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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