Provider Demographics
NPI:1033373691
Name:THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMASTRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-250-3640
Mailing Address - Street 1:1625 HOSPITAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3892
Mailing Address - Country:US
Mailing Address - Phone:843-849-1551
Mailing Address - Fax:843-884-1745
Practice Address - Street 1:1625 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MT. PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-849-1551
Practice Address - Fax:843-884-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical