Provider Demographics
NPI:1922061456
Name:TRIDENT AMBULATORY SURGERY CENTER, L.P.
Entity Type:Organization
Organization Name:TRIDENT AMBULATORY SURGERY CENTER, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:9313 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9155
Mailing Address - Country:US
Mailing Address - Phone:843-797-8992
Mailing Address - Fax:843-797-4071
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-797-8992
Practice Address - Fax:843-797-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF024261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410219Medicaid
SC410219Medicaid