Provider Demographics
NPI:1295163715
Name:BLUFFTON OKATIE SURGERY CENTER, L.L.C.
Entity type:Organization
Organization Name:BLUFFTON OKATIE SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAISTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-213-0723
Mailing Address - Street 1:40 OKATIE CENTER BLVD S
Mailing Address - Street 2:SUITE 125
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7507
Mailing Address - Country:US
Mailing Address - Phone:843-705-8851
Mailing Address - Fax:843-705-8950
Practice Address - Street 1:40 OKATIE CENTER BLVD S
Practice Address - Street 2:SUITE 125
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7507
Practice Address - Country:US
Practice Address - Phone:843-705-8804
Practice Address - Fax:843-705-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-0075261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
42C0001049OtherCMS CERTIFICATION NUMBER (CCN)