Provider Demographics
NPI:1992880330
Name:NEWBERRY INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:NEWBERRY INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-276-5188
Mailing Address - Street 1:2033 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108
Mailing Address - Country:US
Mailing Address - Phone:803-276-5188
Mailing Address - Fax:803-276-9317
Practice Address - Street 1:2033 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108
Practice Address - Country:US
Practice Address - Phone:803-276-5188
Practice Address - Fax:803-276-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7471207R00000X
SC10491207R00000X
SC17777207R00000X
SC25874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA4995Medicaid
D90672Medicare UPIN
G39064Medicare UPIN
D32741Medicare UPIN
SCPA4995Medicaid