Provider Demographics
NPI:1356477368
Name:CHARLES W. SCOWCROFT
Entity Type:Organization
Organization Name:CHARLES W. SCOWCROFT
Other - Org Name:ANDERSON GASTROENTEROLOGY ASSOCIATES,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-225-7401
Mailing Address - Street 1:1530 N FANT ST STE B
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4700
Mailing Address - Country:US
Mailing Address - Phone:864-225-7401
Mailing Address - Fax:864-225-7201
Practice Address - Street 1:1530 N FANT ST STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4700
Practice Address - Country:US
Practice Address - Phone:864-225-7401
Practice Address - Fax:864-225-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC289207R00000X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2324Medicaid
GA000338115AMedicaid
SCGP2324Medicaid
SCGP2324Medicaid