Provider Demographics
NPI:1174500904
Name:CENTER FOR SPECIAL SURGERY
Entity Type:Organization
Organization Name:CENTER FOR SPECIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-7700
Mailing Address - Street 1:209 PATEWOOD DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3581
Mailing Address - Country:US
Mailing Address - Phone:864-527-7700
Mailing Address - Fax:864-527-7701
Practice Address - Street 1:209 PATEWOOD DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3581
Practice Address - Country:US
Practice Address - Phone:864-527-7700
Practice Address - Fax:864-527-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF067DHEC261Q00000X
SCASF-0067261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC041Medicaid
SCASC041Medicaid