MEDICARE: EAST COOPER PHYSICIAN GROUP LLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1174335491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COOPER PHYSICIAN GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 37642
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 S ALLIANCE DR STE 111B
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-7296
Country	:	US
Telephone Number	:	843-971-9350
Fax Number	:	843-971-9351

Authorized Official
Title or Position	:	ENROLLMENT COORDINATOR
Name	:	ABIGAIL KIRKLAND
Credential	:
Telephone Number	:	469-893-2695

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	12/09/2025

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