Provider Demographics
NPI:1003947490
Name:FITTS SURGICAL, LLC
Entity type:Organization
Organization Name:FITTS SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-266-5500
Mailing Address - Street 1:2270 ASHLEY CROSSING DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5732
Mailing Address - Country:US
Mailing Address - Phone:843-266-5500
Mailing Address - Fax:843-266-5505
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:SUITE 155
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5732
Practice Address - Country:US
Practice Address - Phone:843-266-5500
Practice Address - Fax:843-266-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3374Medicaid
SCGP3374Medicaid
SCD80543Medicare UPIN
SC7211Medicare ID - Type UnspecifiedPROVIDER ID
SCGP3374Medicaid