Provider Demographics
NPI:1366405284
Name:BEARWOOD PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:BEARWOOD PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PLASTIC SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:KEENE
Authorized Official - Last Name:HOLDREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-226-7371
Mailing Address - Street 1:3031 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3621
Mailing Address - Country:US
Mailing Address - Phone:864-226-7371
Mailing Address - Fax:864-226-8367
Practice Address - Street 1:3031 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3621
Practice Address - Country:US
Practice Address - Phone:864-226-7371
Practice Address - Fax:864-226-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31311208200000X
SC7807208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC078070Medicaid
SCB922952682Medicare ID - Type Unspecified
SC078070Medicaid