Provider Demographics
NPI:1619930518
Name:MULLINS SURGERY CENTER
Entity Type:Organization
Organization Name:MULLINS SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PARAKKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPALAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-464-4000
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:119 WEST. LOWMAN STREET
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-1014
Mailing Address - Country:US
Mailing Address - Phone:843-464-4000
Mailing Address - Fax:843-464-4017
Practice Address - Street 1:119 W LOWMAN ST
Practice Address - Street 2:119 WEST LOWMAN STREET
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3107
Practice Address - Country:US
Practice Address - Phone:843-464-4000
Practice Address - Fax:843-464-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP079293Medicaid
SCD74151Medicare UPIN
SCGP079293Medicaid