Basic Information
| Provider Information | |||||||||
| NPI: | 1396782512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIRKE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3769 SEA MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295667861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434675972 | ||||||||
| FaxNumber: | 8435078732 | ||||||||
| Practice Location | |||||||||
| Address1: | 3769 SEA MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295667861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434675972 | ||||||||
| FaxNumber: | 8435078732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 21736 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 208200000X | 21736 | SC | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | T58292 | 05 | SC | MEDICAID |