Provider Demographics
NPI:1295773695
Name:SURGICAL ASSOCIATES OF MYRTLE BEACH, LLC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF MYRTLE BEACH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:INGRAM
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-449-9621
Mailing Address - Street 1:845 82ND PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4614
Mailing Address - Country:US
Mailing Address - Phone:843-449-9621
Mailing Address - Fax:843-449-4921
Practice Address - Street 1:845 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4614
Practice Address - Country:US
Practice Address - Phone:843-449-9621
Practice Address - Fax:843-449-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty