MEDICARE: PARKWOOD ORTHOPAEDIC CLINIC L.L.C.

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	:	1811954753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWOOD ORTHOPAEDIC CLINIC L.L.C.

Provider Business Mailing Address
First Line	:	1249 SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-571-5152
Fax Number	:	843-571-5371

Provider Business Practice Location Address
First Line	:	1249 SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-571-5152
Fax Number	:	843-571-5371

Authorized Official
Title or Position	:	OWNER
Name	:	HOWARD BRILLIANT
Credential	:	MD
Telephone Number	:	843-571-5152

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	10/17/2007

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