Provider Demographics
NPI:1912342320
Name:MOUNT PLEASANT SURGICAL, LLC
Entity Type:Organization
Organization Name:MOUNT PLEASANT SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EUSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-793-9803
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-0347
Mailing Address - Country:US
Mailing Address - Phone:843-856-6380
Mailing Address - Fax:
Practice Address - Street 1:1240 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3251
Practice Address - Country:US
Practice Address - Phone:843-856-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC524Medicare UPIN