Provider Demographics
NPI:1639128671
Name:CHARLESTON NEUROSURGICAL
Entity Type:Organization
Organization Name:CHARLESTON NEUROSURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAILE
Authorized Official - Suffix:III
Authorized Official - Credentials:MHA
Authorized Official - Phone:843-723-8823
Mailing Address - Street 1:9275 MEDICAL PLAZA DR STE B
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9140
Mailing Address - Country:US
Mailing Address - Phone:843-553-9300
Mailing Address - Fax:843-569-7651
Practice Address - Street 1:9275 MEDICAL PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9140
Practice Address - Country:US
Practice Address - Phone:843-553-9300
Practice Address - Fax:843-569-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7798207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05441Medicare UPIN
SCE74260Medicare UPIN
SCF63536Medicare UPIN
SCD05565Medicare UPIN