Provider Demographics
NPI:1275717407
Name:LOW COUNTRY PLASTIC SURGERY
Entity Type:Organization
Organization Name:LOW COUNTRY PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-705-8940
Mailing Address - Street 1:40 OKATIE CENTER BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7511
Mailing Address - Country:US
Mailing Address - Phone:843-705-8940
Mailing Address - Fax:843-705-6816
Practice Address - Street 1:40 OKATIE CENTER BLVD
Practice Address - Street 2:STE 350
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909
Practice Address - Country:US
Practice Address - Phone:843-705-8940
Practice Address - Fax:843-705-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT59479Medicaid