Organization
PROVIDENCE ORTHOPAEDIC GROUP, LLC
Active
Other names
Moore Orthopaedic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN MCNALLY (CEO)
(803) 227-8152
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD, SUITE 100, COLUMBIA, SC 29203-9740
(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
Enumeration date
10/07/2010
Last updated
06/02/2011
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