THE PEDIATRIC CLINIC, P.A.
Complete NPI Record 1811995111
Pediatrics in Orangeburg, SC

NPI Status: Active since July 11, 2005

Contact Information

940 HOLLY ST NE
ORANGEBURG, SC
ZIP 29115
Phone: (803) 536-2725
Fax: (803) 534-1441

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Complete NPI Dataset

The following table represents the complete dataset for NPI number 1811995111. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1811995111The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameTHE PEDIATRIC CLINIC, P.A.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address940 HOLLY ST NEThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameORANGEBURGThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameSCThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code291154930The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8035362725The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8035341441The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address940 HOLLY ST NEThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameORANGEBURGThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameSCThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code291154930The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number8035362725The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8035341441The fax number associated with the location address of the provider being identified.
Provider Enumeration Date7/11/2005The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date7/21/2022The date that a record was last updated or changed.
Authorized Official Last NameTHOMASThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NamePEGGYThe first name of the authorized official.
Authorized Official Middle NameC.The middle name of the authorized official.
Authorized Official Title or PositionOFFICE MANAGERThe title or position of the authorized official.
Authorized Official Telephone Number8035362725The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1208000000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1SCThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1GP0966Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1SC
Is Organization SubpartN
Authorized Official Name Prefix TextMRS.
Healthcare Provider Taxonomy Group 1193400000X SINGLE SPECIALTY GROUP