Basic Information
| Provider Information | |||||||||
| NPI: | 1174509244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DRS A MASON AHEARN & WRIGHT G SKINNER III | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAY ORTHOPEDIC ASSOCIATION LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1777 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294421777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435274447 | ||||||||
| FaxNumber: | 8435276423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N FRASER ST | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294402848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435274447 | ||||||||
| FaxNumber: | 8435276423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCURDY | ||||||||
| AuthorizedOfficialFirstName: | GINI | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8435274447 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | AN56 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1447236815 | 01 | SC | NPI | OTHER | 1255317624 | 01 | SC | NPI | OTHER | 200042355 | 01 | SC | RAILROAD PROVIDER NUMBER | OTHER | 200042667 | 01 | SC | RAILROAD PROVIDER NUMBER | OTHER | DM0379 | 01 | SC | MEDICAID DMERC | OTHER |