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SOUTHERN SURGICAL PA NPI 1699859355


NPI Information

NPI: 1699859355
Provider Name: SOUTHERN SURGICAL, PA
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 42D0251920

Address:
3600 SEA MOUNTAIN HWY
SUITE A
LITTLE RIVER, SC
ZIP 29566
Phone: (843) 399-9774
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SOUTHERN SURGICAL, PA is a specialist in Little River, SC. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTHERN SURGICAL, PA NPI is 1699859355. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3600 SEA MOUNTAIN HWY
SUITE A
LITTLE RIVER, SC
ZIP 29566-161
Phone: (843) 399-9774
Fax: (843) 399-8657

The provider's authorized official is Wilma F Pond .
The authorized official title is Office Manager and has the following contact phone number (843) 399-9774.

The CLIA number assigned to this NPI record is 42D0251920 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/25/2006 and was last updated on 1/25/2011.


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
1174400000XSpecialistYes

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=========OTHERTAX ID NUMBER
2890625VMEDICAIDNORTH CAROLINA
35067MEDICARE ID-TYPE UNSPECIFIEDMEDICARE PROVIDER NUMBER
4GP1384MEDICAIDSOUTH 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: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.