Healthcare Provider Details

I. General information

NPI: 1760483382
Provider Name (Legal Business Name): SOUTH CAROLINA INTERNAL MEDICINE ASSOCIATES AND REHABILITATION,L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7182 WOODROW ST STE 200
IRMO SC
29063-2958
US

IV. Provider business mailing address

7182 WOODROW ST STE 200
IRMO SC
29063-2832
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-1111
  • Fax: 803-749-0050
Mailing address:
  • Phone: 803-749-1111
  • Fax: 803-749-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11481
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21980
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11931
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11901
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11871
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number17388
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10531
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMPA 1942 TL
License Number StateSC

VIII. Authorized Official

Name: BENJAMIN J LEVINSON
Title or Position: MANAGEING PARTNER
Credential: MD
Phone: 803-749-1111