Provider Demographics
NPI:1164578266
Name:WINYAH SURGICAL SPECIALISTS, PA
Entity Type:Organization
Organization Name:WINYAH SURGICAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-545-8850
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-9998
Mailing Address - Country:US
Mailing Address - Phone:843-545-8850
Mailing Address - Fax:843-545-5081
Practice Address - Street 1:14490 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-9998
Practice Address - Country:US
Practice Address - Phone:843-545-8850
Practice Address - Fax:843-545-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2686Medicaid
SC6593Medicare ID - Type UnspecifiedGROUP MEDICARE
SCGP2686Medicaid