Provider Demographics
NPI:1437319027
Name:FLORENCE SURGERY & LASER CENTER LLC
Entity Type:Organization
Organization Name:FLORENCE SURGERY & LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-664-9393
Mailing Address - Street 1:400 N CASHUA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2098
Mailing Address - Country:US
Mailing Address - Phone:843-664-9393
Mailing Address - Fax:843-664-2301
Practice Address - Street 1:400 N CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-664-9393
Practice Address - Fax:843-664-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC802523261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409931Medicaid
SCASC043Medicaid
NC3409931Medicaid