Provider Demographics
NPI:1033251160
Name:WACCAMAW ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:WACCAMAW ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-527-3428
Mailing Address - Street 1:1011 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2848
Mailing Address - Country:US
Mailing Address - Phone:843-527-3428
Mailing Address - Fax:
Practice Address - Street 1:2361 NORTH FRASER STREET
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440
Practice Address - Country:US
Practice Address - Phone:843-527-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center