MEDICARE: RAMIRO JAY GODINES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	16289	SC
2	207L00000X	Anesthesiology Physician	16289	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073596631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMIRO JAY GODINES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2024
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-2024
Country	:	US
Telephone Number	:	706-660-8505
Fax Number	:	706-660-9390

Provider Business Practice Location Address
First Line	:	3655 MITCHELL ST
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2827
Country	:	US
Telephone Number	:	843-716-7000
Fax Number	:	706-660-9390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/27/2024

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Directions to “ RAMIRO JAY GODINES M.D.” Practice Location

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