Provider Demographics
NPI:1760888127
Name:SEASIDE PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:SEASIDE PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-757-5559
Mailing Address - Street 1:25 SHERINGTON PARK DRIVE
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-757-5559
Mailing Address - Fax:843-757-5546
Practice Address - Street 1:25 SHERINGTON PARK DRIVE
Practice Address - Street 2:SUITE D-1
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-757-5559
Practice Address - Fax:843-757-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty