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General NPI Number Information
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NPI Number | 1124512454
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Entity Type | Individual
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Provider Name | PHILLIPS RUTH DERIDDER MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 9 RICHLAND MEDICAL PARK DR STE 530
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City | COLUMBIA
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State | SC
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Zip | 29203-6870
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Country | US
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Telephone | 803-434-4603
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Fax | 803-434-7983
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-695-6697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LL52457
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 52457
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | LL52457
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License Number State | SC
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