Provider Demographics
NPI:1295772754
Name:ORVILLE, STEPHEN W (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:ORVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4810
Mailing Address - Country:US
Mailing Address - Phone:803-791-2000
Mailing Address - Fax:803-939-4579
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:803-939-4579
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-00692207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-10829Medicaid
NC10829OtherBCBSNC
SC164299Medicaid
NC930116788OtherRR MEDICARE
NC930116788OtherRR MEDICARE
SC164299Medicaid
SCF507818036Medicare PIN