Provider Demographics
NPI:1023140068
Name:MID-CAROLINA SURGERY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:MID-CAROLINA SURGERY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-286-8211
Mailing Address - Street 1:1010A N WOODLAND DR
Mailing Address - Street 2:MEDICAL ARTS BUILDING #3
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-1966
Mailing Address - Country:US
Mailing Address - Phone:803-286-8211
Mailing Address - Fax:803-286-8214
Practice Address - Street 1:1010A N WOODLAND DR
Practice Address - Street 2:MEDICAL ARTS BUILDING #3
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-1966
Practice Address - Country:US
Practice Address - Phone:803-286-8211
Practice Address - Fax:803-286-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC172789208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1395JOtherBCBS
SCGP1671Medicaid
NC1395JOtherBCBS
NC2272326Medicare PIN
SCF02530Medicare UPIN