Provider Demographics
NPI:1932132065
Name:AMBULATORY SURGICAL CTR OF AIKEN LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGICAL CTR OF AIKEN LLC
Other - Org Name:THE SURGERY CENTER OF AIKEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR OF BOARD/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-648-2840
Mailing Address - Street 1:4211 TROLLEY LINE RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2749
Mailing Address - Country:US
Mailing Address - Phone:803-648-2840
Mailing Address - Fax:803-648-8117
Practice Address - Street 1:4211 TROLLEY LINE RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2749
Practice Address - Country:US
Practice Address - Phone:803-648-2840
Practice Address - Fax:803-648-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF096261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC064Medicaid
SCQ341140001Medicare PIN
SCQ341140001Medicare UPIN