MEDICARE: CAROLINA AESTHETIC PLASTIC SURGERY INSTITUTE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093764789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA AESTHETIC PLASTIC SURGERY INSTITUTE PA

Provider Business Mailing Address
First Line	:	180 WINGO WAY
Second Line	:	SUITE 205
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1810
Country	:	US
Telephone Number	:	843-884-1400
Fax Number	:	843-884-7448

Provider Business Practice Location Address
First Line	:	180 WINGO WAY
Second Line	:	SUITE 205
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1810
Country	:	US
Telephone Number	:	843-884-1400
Fax Number	:	843-884-7448

Authorized Official
Title or Position	:	OFFICE MANAGER DIRECTOR
Name	:	KENDRA CHRISTMAS
Credential	:
Telephone Number	:	843-884-1400

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/16/2013

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