Provider Demographics
NPI:1457327132
Name:SURGICAL SERVICES OF COLUMBIA, LLC
Entity Type:Organization
Organization Name:SURGICAL SERVICES OF COLUMBIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-779-0277
Mailing Address - Street 1:1707 BERNARDIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2004
Mailing Address - Country:US
Mailing Address - Phone:803-779-0277
Mailing Address - Fax:803-779-0275
Practice Address - Street 1:1707 BERNARDIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2004
Practice Address - Country:US
Practice Address - Phone:803-779-0277
Practice Address - Fax:803-779-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3887Medicaid
SC7802Medicare ID - Type Unspecified