Provider Demographics
NPI:1689610982
Name:CAROLINA SURG ASSOC PA
Entity Type:Organization
Organization Name:CAROLINA SURG ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SABBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-797-5353
Mailing Address - Street 1:9326 MEDICAL PLAZA DR
Mailing Address - Street 2:STE D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9138
Mailing Address - Country:US
Mailing Address - Phone:843-797-5353
Mailing Address - Fax:843-797-6496
Practice Address - Street 1:9326 MEDICAL PLAZA DR
Practice Address - Street 2:STE D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9138
Practice Address - Country:US
Practice Address - Phone:843-797-5353
Practice Address - Fax:843-797-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC6699208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1658Medicaid
B92400Medicare UPIN
SCPA1658Medicaid