MEDICARE: DR. JAMES M. O'MALLEY 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	207R00000X	Internal Medicine Physician	33229	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

General Provider Information

NPI Number	:	1760476980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M. O'MALLEY M.D.

Provider Business Mailing Address
First Line	:	40 OKATIE CENTER BLVD S STE 100
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7519
Country	:	US
Telephone Number	:	843-705-8888
Fax Number	:	843-705-7024

Provider Business Practice Location Address
First Line	:	40 OKATIE CENTER BLVD S STE 100
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7519
Country	:	US
Telephone Number	:	843-705-8888
Fax Number	:	843-705-7024

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	11/27/2012

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