Provider Demographics
NPI:1275596264
Name:CAROLINA REGIONAL SURGERY CENTER. LTD
Entity Type:Organization
Organization Name:CAROLINA REGIONAL SURGERY CENTER. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:1021 MEDICAL CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4618
Mailing Address - Country:US
Mailing Address - Phone:843-449-7885
Mailing Address - Fax:843-497-5137
Practice Address - Street 1:1021 MEDICAL CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4618
Practice Address - Country:US
Practice Address - Phone:843-449-7885
Practice Address - Fax:843-497-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF069261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410148Medicaid
SCQ311520001Medicare PIN