Basic Information
| Provider Information | |||||||||
| NPI: | 1417342247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENDON POPE | ||||||||
| FirstName: | EMI | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 RIBAUT RD | ||||||||
| Address2: | BMAC CREDENTIALING | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299025441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437700404 | ||||||||
| FaxNumber: | 8442962308 | ||||||||
| Practice Location | |||||||||
| Address1: | BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP | ||||||||
| Address2: | 300 MIDTOWN DRIVE | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437700404 | ||||||||
| FaxNumber: | 8442962308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 52583 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 525836 | 05 | SC | MEDICAID |