Provider Demographics
NPI:1770009995
Name:LOW COUNTRY SURGICAL ASSISTANTS LLC
Entity Type:Organization
Organization Name:LOW COUNTRY SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-585-5581
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-1460
Mailing Address - Country:US
Mailing Address - Phone:352-585-5581
Mailing Address - Fax:
Practice Address - Street 1:1316 HEARTHSTONE DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7088
Practice Address - Country:US
Practice Address - Phone:352-585-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty