Provider Demographics
NPI:1235514225
Name:T J REARDON MD LLC
Entity type:Organization
Organization Name:T J REARDON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-237-1184
Mailing Address - Street 1:671 JAMESTOWN DR
Mailing Address - Street 2:STE 202A
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7507
Mailing Address - Country:US
Mailing Address - Phone:864-237-1184
Mailing Address - Fax:
Practice Address - Street 1:671 JAMESTOWN DR
Practice Address - Street 2:STE 202A
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7507
Practice Address - Country:US
Practice Address - Phone:864-237-1184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care