KINGSTREE SURGICAL ASSOCIATES (NPI# 1962691022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962691022 |
| Entity Type | Organization |
| Organization Name | KINGSTREE SURGICAL ASSOCIATES |
| Practice Address |
135 N Academy St Kingstree SC 29556-3421 |
| Practice Telephone | 8037318393 |
| Mailing Telephone | 8037318393 |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-12-06 |
| Authorized Official Name | BLAKE H MOORE (PRESIDENT) |
| Authorized Official Telephone | 8433555462 |
| Authorized Official Credential | MD, FACS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 21490 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | DEA | BM4461872 | 01 |
| SC | T56301 | 05 | |
| SC | LICENSE | 21490 | 01 |
| Street Address |
135 N ACADEMY ST |
| City | KINGSTREE |
| State | SC |
| Zip Code | 29556-3421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689198996 | April Wilson | Home Health Aide | 706 Sandy Bay Rd, Kingstree, SC 29556 | 2017-07-28 |
| 1588000657 | Jennifer Moore Lamb | Registered Nurse | 500 North Academy St, Building K, Kingstree, SC 29556 | 2013-05-16 |
| 1619227014 | Hallie Mcnair Dubose | Pharmacist | 120 North Longstreet St, Kingstree, SC 29556 | 2012-09-12 |
| 1699969733 | Black River Healthcare, Inc. | Obstetrics & Gynecology | 500 Thurgood Marshall Boulevard, Suite A, Kingstree, SC 29556 | 2007-08-31 |
| 1457578486 | Dawkins Medical Transport | Ambulance | 89 Drylog Avenue, Kingstree, SC 29556 | 2007-04-19 |
| 1306971502 | Vital Aging of Williamsburg County, Inc. | Home Delivered Meals | 501 North Longstreet Street, Kingstree, SC 29556 | 2007-02-21 |
| 1356489579 | Harry Wells Floyd | General Practice | 500 Thurgood Marshall Blvd, Suite F, Kingstree, SC 29556 | 2007-02-01 |
| 1306995782 | Joann Conyers Lockhart | Health Educator | 500 Academy Street, Kingstree, SC 29556 | 2007-01-09 |
| 1497825723 | The Youth Academy Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 237 Lela Harrison Road, Kingstree, SC 29556 | 2006-11-08 |
| 1427151109 | South Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 120 N Longst St, Kingstree, SC 29556 | 2006-09-07 |
| Find all providers in zip 29556 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427044742 | Mark Dee Fiedler | Surgery | 500 Nelson Blvd, Kingstree, SC 29556-4027 | 2005-09-22 |
| 1821226846 | Surgeoncare Physicians of South Carolina, LLC | Surgery | 500 Nelson Blvd, Kingstree, SC 29556-4027 | 2009-06-29 |
| 1306924311 | Williamsburg Surgical | Surgery | 500 Nelson Blvd, Kingstree, SC 29556-4027 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538785282 | Christopher James Levy | Surgery | Prisma Health Medical Group General Surgery, 2 Medical Park, Ste 300, Collumbia, SC 29203 | 2020-06-18 |
| 1881219137 | Meredith Elizabeth Taylor | Surgery | 96 Jonathan Lucas St # 613, Charleston, SC 29425-8900 | 2020-06-12 |
| 1073136511 | Trey Jeffrey Mathews | Surgery | 101 E. Wood St, Spartanburg, SC 29303-3098 | 2020-05-19 |
| 1356984322 | Katelyn Tuley | Surgery | 210 Village Center Blvd Ste 140, Myrtle Beach, SC 29579-6706 | 2019-10-23 |
| 1477114569 | Justin Robert Silverman | Surgery | 169 Ashley Avenue, Room 202 Muh, Msc 333, Charleston, SC 29425 | 2019-06-28 |
| 1104485648 | Gregory Tyler Rives | Surgery | 96 Jonathan Lucas St Csb 423-a / Msc 613, Charleston, SC 29425-0001 | 2019-06-09 |
| 1396220554 | Spartanburg Medical Center | Surgery | 840 W Floyd Baker Blvd Ste B, Gaffney, SC 29341-1845 | 2018-10-03 |
| 1659853596 | Roper Saint Francis Physicians Network | Surgery | 300 Callen Blvd, Summerville, SC 29486-2809 | 2018-09-06 |
| 1336633569 | Lytani Wilson | Surgery | 96 Jonathan Lucas St # 423, Charleston, SC 29425 | 2018-06-20 |
| 1609360890 | Alicia Marie Stafford | Surgery | 169 Ashley Avenue Rm 202 Main Hospital, Msc333, Charleston, SC 29425 | 2018-06-20 |
| 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.