MEDICARE: MICHAEL D. RICHARDS PA-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	363A00000X	Physician Assistant	A543	SC
2	363AS0400X	Surgical Physician Assistant	543	SC
3	363A00000X	Physician Assistant	543	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	S826798946	OTHER	SC	MEDICARE PTAN

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811969975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D. RICHARDS PA-C

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-695-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 ROBERTS BRANCH PKWY STE 200
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-9144
Country	:	US
Telephone Number	:	803-296-9206
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	11/10/2025

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Directions to “ MICHAEL D. RICHARDS PA-C” Practice Location

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