Provider Demographics
NPI:1093749376
Name:UROLOGY SURGERY CENTER,LLC
Entity Type:Organization
Organization Name:UROLOGY SURGERY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-796-9968
Mailing Address - Street 1:139 SUMMERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-796-9968
Mailing Address - Fax:803-791-0376
Practice Address - Street 1:139 SUMMERPLACE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-796-9968
Practice Address - Fax:803-791-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC022Medicaid
SCASC022Medicaid
SCQ322290001Medicare PIN