1487630554 NPI number — JORGE O GARCIA, M.D., LLC

Table of content: (NPI 1487630554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487630554 NPI number — JORGE O GARCIA, M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGE O GARCIA, M.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EMMANUEL FAMILY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487630554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2531 EVANS ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NEWBERRY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29108-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-276-7978
Provider Business Mailing Address Fax Number:
803-675-0750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2531 EVANS ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEWBERRY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29108-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-276-7978
Provider Business Practice Location Address Fax Number:
803-675-0750
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
803-276-7978

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP3499 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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