Provider Demographics
NPI:1740643683
Name:SSI ADMIN, LLC
Entity type:Organization
Organization Name:SSI ADMIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-650-4006
Mailing Address - Street 1:1945 GLENNS BAY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4833
Mailing Address - Country:US
Mailing Address - Phone:843-650-4006
Mailing Address - Fax:843-650-4019
Practice Address - Street 1:1945 GLENNS BAY RD
Practice Address - Street 2:SUITE B
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4833
Practice Address - Country:US
Practice Address - Phone:843-650-4006
Practice Address - Fax:843-650-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty