TRICIA L ETHERIDGE (NPI# 1366531162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366531162 |
| Entity Type | Individual |
| Full Name | TRICIA L ETHERIDGE |
| Credential | M.D. |
| Practice Address |
109 S Green St Ridgeland SC 29936-9165 |
| Practice Telephone | 8437266773 |
| Practice Fax Number | 8437266778 |
| Mailing Telephone | 8437266773 |
| Mailing Fax Number | 8437266778 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-12-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 19547 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | TAX ID | 320114664 | 01 |
| SC | LICENSE # | 19547 | 01 |
| SC | L25587 | 05 | |
| SC | CLIA | 42D1028556 | 01 |
| SC | BLUE CROSS BLUE SHIELD | 320114664 | 01 |
| SC | RAIL ROAD MEDICARE | DC4084 | 01 |
| Street Address |
109 S GREEN ST |
| City | RIDGELAND |
| State | SC |
| Zip Code | 29936-9165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578620480 | Tricia Etheridge, Md, PC | Family Medicine | 109 S Green St, Ridgeland, SC 29936-9165 | 2007-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699316075 | Ghc-hilton Head, LLC | Hospice Care, Community Based | 65 Schinger Avenue, Suite 103, Ridgeland, SC 29936 | 2019-10-07 |
| 1568884385 | Kristen Reeves | Occupational Therapist | 10616 South Jacob Smart Boulevard, Ridgeland, SC 29936 | 2014-01-14 |
| 1942547138 | Jennifer Loadholt Moore | Social Worker | 204 North Railroad Avenue, Ridgeland, SC 29936 | 2013-01-09 |
| 1568719649 | Jennifer Lynn Coleman | Counselor | 203 N. Railroad Ave., Ridgeland, SC 29936 | 2012-08-08 |
| 1184945925 | Niles Edemeka Carter | Obstetrics & Gynecology | 1320 S. Ribaut Rd, Port Royal, SC 29936 | 2010-06-16 |
| 1831328459 | Jamie Singleton | Pediatrics | 1320 S. Ribaut Rd., Beaufort, SC 29936 | 2009-07-02 |
| 1487801668 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 721 Okatie Hwy 170, Ridgeland, SC 29936 | 2008-08-19 |
| 1295912004 | Ridgeland Dialysis LLC | Clinic/Center | 112 Weathersbee St, Ridgeland, SC 29936 | 2008-01-23 |
| 1518143221 | Ridgeland Eye Associates LLC | Ophthalmology | 10668 South Jacob Smart Boulevard, Ridgeland, SC 29936 | 2008-01-11 |
| 1053594713 | Caring Hands Health Equipment & Supplies, Inc. | Durable Medical Equipment & Medical Supplies | 107d East Main Street, Ridgeland, SC 29936 | 2007-12-17 |
| Find all providers in zip 29936 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
| 1942740188 | Personalized Wellness | General Practice | 573 Highway 51 Ste D, Ridgeland, MS 39157-2605 | 2017-03-07 |
| 1093263410 | Natural Health Project LLC | General Practice | 555 Highway 51, Ridgeland, MS 39157 | 2016-09-14 |
| 1821589318 | Trustcare Clinics, LLC | General Practice | 361 Township Ave Ste 200, Ridgeland, MS 39157 | 2018-05-21 |
| 1891748463 | Chatchaval Vuthiganon | General Practice | 1506 Grays Highway, Suite C, Ridgeland, SC 29936 | 2006-05-17 |
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| 1306326640 | Orange Cut Rate Drug Store, Inc | General Practice | 1326 Grove Park Dr, Orangeburg, SC 29115 | 2018-08-16 |
| 1841704244 | Modern Concepts, LLC | General Practice | 1808 Second Baxter Xing Ste 108, Fort Mill, SC 29708 | 2017-11-21 |
| 1245744937 | Carolina Healthchoice of Greenville, LLC | General Practice | 274 Commonwealth Dr Ste B, Greenville, SC 29615-4872 | 2017-11-17 |
| 1861937377 | Doctors Care Sc, Pa | General Practice | 8384 Charlotte Highway, Indian Land, SC 29707-6532 | 2016-12-20 |
| 1790138014 | Beaufort-jasper-hampton Comprehensive Health Services Inc. | General Practice | 2210-b Mossy Oaks Rd., Port Royal, SC 29935-1046 | 2016-07-21 |
| 1659726438 | Inspire Medical Services | General Practice | 104 Berkeley Square Ln, Ste 63, Goose Creek, SC 29445-2958 | 2016-04-28 |
| 1609240910 | Eating Recovery Center-the Carolinas | General Practice | 12 Maple Tree Court, Suite 101, Greenville, SC 29615-4079 | 2015-11-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.