Provider Demographics
NPI:1750339669
Name:HILTON HEAD LAPAROSCOPIC AND GENERAL SURGERY PA
Entity type:Organization
Organization Name:HILTON HEAD LAPAROSCOPIC AND GENERAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-681-9489
Mailing Address - Street 1:25 HOSPITAL CENTER COMMON
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 HOSPITAL CENTER COMMON
Practice Address - Street 2:SUITE 100
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2841
Practice Address - Country:US
Practice Address - Phone:843-681-9489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6892Medicare ID - Type Unspecified