Provider Demographics
NPI:1588627780
Name:THE SURGERY CENTER OF BEAUFORT LLC
Entity Type:Organization
Organization Name:THE SURGERY CENTER OF BEAUFORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVEC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-322-5854
Mailing Address - Street 1:1033 RIBAUT ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902
Mailing Address - Country:US
Mailing Address - Phone:843-322-5800
Mailing Address - Fax:843-522-0591
Practice Address - Street 1:1033 RIBAUT ROAD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-322-5800
Practice Address - Fax:843-522-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-048261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC026Medicaid
Q32243001Medicare ID - Type Unspecified