Provider Demographics
NPI:1619935483
Name:OUTPATIENT SURGERY CENTER OF HILTON HEAD
Entity Type:Organization
Organization Name:OUTPATIENT SURGERY CENTER OF HILTON HEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-682-5001
Mailing Address - Street 1:190 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2389
Mailing Address - Country:US
Mailing Address - Phone:843-682-5002
Mailing Address - Fax:843-682-5041
Practice Address - Street 1:190 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2389
Practice Address - Country:US
Practice Address - Phone:843-682-5002
Practice Address - Fax:843-682-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-092261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC061Medicaid
SCY34431Medicare UPIN