Provider Demographics
NPI:1760841035
Name:WEST ASHLEY COLONOSCOPY CENTER
Entity Type:Organization
Organization Name:WEST ASHLEY COLONOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-556-1285
Mailing Address - Street 1:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-1178
Mailing Address - Country:US
Mailing Address - Phone:843-556-1285
Mailing Address - Fax:843-556-1286
Practice Address - Street 1:1616 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5902
Practice Address - Country:US
Practice Address - Phone:843-556-1285
Practice Address - Fax:843-556-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty