Provider Demographics
NPI:1376528950
Name:SURGICAL ASSOCIATES OF CHARLESTON, P.A.
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF CHARLESTON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-723-6426
Mailing Address - Street 1:510 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7540
Mailing Address - Country:US
Mailing Address - Phone:843-723-6426
Mailing Address - Fax:843-722-2193
Practice Address - Street 1:510 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7540
Practice Address - Country:US
Practice Address - Phone:843-723-6426
Practice Address - Fax:843-722-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD17777Medicare UPIN
SCC60589Medicare UPIN
SCI32381Medicare UPIN
SCE62038Medicare UPIN
SCE84163Medicare UPIN
SCC71109Medicare UPIN