COLLETON AMBULATORY CARE LLC NPI 1114957891

NPI Information

NPI: 1114957891
Provider Name: COLLETON AMBULATORY CARE, LLC
Classification: Clinic/Center - 261QA1903X
Specialization: Ambulatory Surgical
Entity Type: Organization
:
Address: 304 MEDICAL PARK DR
WALTERBORO, SC
ZIP 29488
Phone: (843) 782-2700

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NPI Details

COLLETON AMBULATORY CARE, LLC is an ambulatory surgical clinic center in Walterboro, SC. COLLETON AMBULATORY CARE, LLC NPI is 1114957891. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

304 MEDICAL PARK DR
WALTERBORO, SC
ZIP 29488-743
Phone: (843) 782-2700
Fax: (843) 782-2701

The provider's authorized official is Deron Smith .
The authorized official title is Administrator and has the following contact phone number (843) 782-2610.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Removal of cataract with insertion of prosthetic lens (HCPCS:66984)
Removal of recurring cataract in lens capsule using a laser (HCPCS:66821)

The enumeration date for this NPI number is 7/5/2006 and was last updated on 10/1/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	ASF-035	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ASC014	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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