Provider Demographics
NPI:1992123822
Name:ACCIDENT INJURY AND REHABILITATION PC
Entity type:Organization
Organization Name:ACCIDENT INJURY AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-669-1010
Mailing Address - Street 1:507 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4427
Mailing Address - Country:US
Mailing Address - Phone:843-669-1010
Mailing Address - Fax:843-669-1054
Practice Address - Street 1:507 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4427
Practice Address - Country:US
Practice Address - Phone:843-669-1010
Practice Address - Fax:843-669-1054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCIDENT INJURY AND REHABILITATION PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2474111NR0400X, 332B00000X
SC11313204C00000X, 207Q00000X
SC4108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3399Medicaid
SCDE3399Medicaid