Healthcare Provider Details

I. General information

NPI: 1730296310
Provider Name (Legal Business Name): MOORE ORTHOPAEDIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE PLEX 741 FASHION DRIVE
COLUMBIA SC
29229
US

IV. Provider business mailing address

PO BOX 843384
BOSTON MA
02284-3384
US

V. Phone/Fax

Practice location:
  • Phone: 803-227-8005
  • Fax:
Mailing address:
  • Phone: 803-227-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN MCNALLY
Title or Position: CEO
Credential:
Phone: 803-227-8152