Organization
SOUTH CAROLINA SPORTS MEDICINE & ORTHOPAEDIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW PIHLBLAD MCWILLIAMS (CFO)
(843) 569-3367
Entity
Organization
Contact information
Practice address
9100 MEDCOM ST, N CHARLESTON, SC 29406-9188
(843) 572-2663
(843) 764-3577
Mailing address
9100 MEDCOM ST, NORTH CHARLESTON, SC 29406-9188
(843) 569-3367
(843) 764-3577
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0253030001
DMERIC ID
—
05
—
GP0078
—
SC
Enumeration date
08/16/2006
Last updated
06/27/2024
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