Provider Demographics
NPI:1326193418
Name:ADVANCE LASER & MINIMALLY INVASIVE SURGERY
Entity Type:Organization
Organization Name:ADVANCE LASER & MINIMALLY INVASIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:SCHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-236-5098
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0259
Mailing Address - Country:US
Mailing Address - Phone:864-236-5098
Mailing Address - Fax:864-236-7461
Practice Address - Street 1:3150 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-9498
Practice Address - Country:US
Practice Address - Phone:864-236-5098
Practice Address - Fax:864-236-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82106Medicare UPIN