Provider Demographics
NPI:1407838063
Name:SOUTH CAROLINA MEDICAL ENDOSCOPY, INC.
Entity Type:Organization
Organization Name:SOUTH CAROLINA MEDICAL ENDOSCOPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:803-254-8449
Mailing Address - Street 1:2631 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2363
Mailing Address - Country:US
Mailing Address - Phone:803-254-8449
Mailing Address - Fax:803-254-8984
Practice Address - Street 1:2631 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2363
Practice Address - Country:US
Practice Address - Phone:803-254-8449
Practice Address - Fax:803-254-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-042261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC021Medicaid
SCASC021Medicaid