Provider Demographics
NPI:1144228883
Name:RENEWALASC, LLC
Entity Type:Organization
Organization Name:RENEWALASC, LLC
Other - Org Name:SHANKLIN PLASTIC SURGERY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPB, CPRC
Authorized Official - Phone:912-920-5624
Mailing Address - Street 1:900 MOHAWK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1780
Mailing Address - Country:US
Mailing Address - Phone:912-920-2090
Mailing Address - Fax:912-920-4114
Practice Address - Street 1:900 MOHAWK ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-920-2090
Practice Address - Fax:912-920-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025270261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582173090AMedicaid
SCP00056413Medicare PIN