Provider Demographics
NPI:1174588206
Name:CHARLESTON SURGERY CENTER LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:CHARLESTON SURGERY CENTER LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-628-5816
Mailing Address - Street 1:130 EDGE ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-3002
Mailing Address - Country:US
Mailing Address - Phone:843-628-5816
Mailing Address - Fax:864-630-7811
Practice Address - Street 1:130 EDGE ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486
Practice Address - Country:US
Practice Address - Phone:843-628-5816
Practice Address - Fax:864-630-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490000945OtherHISTORICAL DATA
SCQ261510001Medicare PIN
42C0001011Medicare Oscar/Certification