Provider Demographics
NPI:1235232182
Name:SCCA, LLC
Entity Type:Organization
Organization Name:SCCA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:SCHLESINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-766-3301
Mailing Address - Street 1:PO BOX 13509
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3509
Mailing Address - Country:US
Mailing Address - Phone:843-766-3301
Mailing Address - Fax:843-762-3913
Practice Address - Street 1:730 STONY LANDING ROAD
Practice Address - Street 2:ROPER ST. FRANCIS MEDICAL CENTER BERKELEY
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-766-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14466207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC144668Medicaid
SC144668Medicaid
SCC863330281Medicare ID - Type Unspecified