Provider Demographics
NPI:1093764789
Name:CAROLINA AESTHETIC PLASTIC SURGERY INSTITUTE PA
Entity Type:Organization
Organization Name:CAROLINA AESTHETIC PLASTIC SURGERY INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-1400
Mailing Address - Street 1:180 WINGO WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1810
Mailing Address - Country:US
Mailing Address - Phone:843-884-1400
Mailing Address - Fax:843-884-7448
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-1400
Practice Address - Fax:843-884-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3944Medicaid
I04633Medicare UPIN
SCGP3944Medicaid