Provider Demographics
NPI:1760483382
Name:SOUTH CAROLINA INTERNAL MEDICINE ASSOCIATES AND REHABILITATION,L.L.C.
Entity type:Organization
Organization Name:SOUTH CAROLINA INTERNAL MEDICINE ASSOCIATES AND REHABILITATION,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-749-1111
Mailing Address - Street 1:7182 WOODROW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2832
Mailing Address - Country:US
Mailing Address - Phone:803-749-1111
Mailing Address - Fax:803-749-0050
Practice Address - Street 1:7182 WOODROW ST STE 200
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2958
Practice Address - Country:US
Practice Address - Phone:803-749-1111
Practice Address - Fax:803-749-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11931207R00000X
SC11871207RC0000X
SC17388208100000X
SC10531208600000X
SCMPA 1942 TL363AM0700X
SC11481207QA0505X
SC21980207R00000X
SC11901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCI9660OtherRAILROAD MEDICARE
SCGP2478Medicaid
SC1760483382OtherRAILROAD MEDICARE
SC110188005OtherRAILROAD MEDICARE
SCGP2478Medicaid
SC110188005OtherRAILROAD MEDICARE
SC1760483382OtherRAILROAD MEDICARE
SC6246Medicare PIN