Provider Demographics
NPI:1942368279
Name:LOWCOUNTRY PLASTIC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LOWCOUNTRY PLASTIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-971-2860
Mailing Address - Street 1:1205 TWO ISLAND CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7406
Mailing Address - Country:US
Mailing Address - Phone:843-971-2860
Mailing Address - Fax:843-971-0660
Practice Address - Street 1:1205 TWO ISLAND CT
Practice Address - Street 2:SUITE 203
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7406
Practice Address - Country:US
Practice Address - Phone:843-971-2860
Practice Address - Fax:843-971-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18370208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3224Medicaid
SC183704Medicaid
SC183704Medicaid
SCGP3224Medicaid