Basic Information
| Provider Information | |||||||||
| NPI: | 1083644355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMLICH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | HALPIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2880 TRICOM ST | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437975050 | ||||||||
| FaxNumber: | 8437973633 | ||||||||
| Practice Location | |||||||||
| Address1: | 2880 TRICOM ST | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437975050 | ||||||||
| FaxNumber: | 8437973633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 16856 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 16856 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1326287434 | 01 | SC | MEDICAID DME NPI | OTHER | 168561 | 05 | SC | MEDICAID |