Provider Demographics
NPI:1891932901
Name:BARNWELL SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:BARNWELL SURGICAL ASSOCIATES
Other - Org Name:BARNWELL COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:CFO
Authorized Official - Phone:803-541-4161
Mailing Address - Street 1:1184 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-2162
Mailing Address - Country:US
Mailing Address - Phone:803-259-2512
Mailing Address - Fax:803-254-2514
Practice Address - Street 1:1184 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-2162
Practice Address - Country:US
Practice Address - Phone:803-259-2512
Practice Address - Fax:803-254-2514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARNWELL COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-12
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30675208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC306751Medicaid
SC306751Medicaid