Provider Demographics
NPI:1003861337
Name:CSC ACQUISITION, LLC
Entity Type:Organization
Organization Name:CSC ACQUISITION, LLC
Other - Org Name:COLUMBIA SKIN CLINC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:803-779-7316
Mailing Address - Street 1:3600 FOREST DR STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4057
Mailing Address - Country:US
Mailing Address - Phone:803-779-7316
Mailing Address - Fax:803-343-2538
Practice Address - Street 1:1 WELLNESS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2872
Practice Address - Country:US
Practice Address - Phone:803-779-7316
Practice Address - Fax:803-343-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7480OtherMEDICARE PTAN
SC7480OtherMEDICARE PTAN