Provider Demographics
NPI:1073505038
Name:PALMETTO SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PALMETTO SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-865-8200
Mailing Address - Street 1:109 BLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6244
Mailing Address - Country:US
Mailing Address - Phone:803-865-8200
Mailing Address - Fax:803-419-7910
Practice Address - Street 1:109 BLARNEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6244
Practice Address - Country:US
Practice Address - Phone:803-865-8200
Practice Address - Fax:803-419-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF 046261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC 024Medicaid
SCASF 046OtherDHEC LICENSE NUMBER
SCQ322940001Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
SCASC 024Medicaid