Provider Demographics
NPI:1467770206
Name:CAROLINA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:CAROLINA SURGERY CENTER LLC
Other - Org Name:SURGERY CENTER AT EDGEWATER CRNA GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-286-1481
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65302-1547
Mailing Address - Country:US
Mailing Address - Phone:660-826-5960
Mailing Address - Fax:
Practice Address - Street 1:2536 LENGERS WAY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7126
Practice Address - Country:US
Practice Address - Phone:803-802-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5434Medicaid
SCDR3018OtherRR MEDICARE
NC8053845Medicaid
SC9532Medicare PIN