MEDICARE: LOWCOUNTRY PLASTIC SURGERY CENTER LLC

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	208200000X	Plastic Surgery Physician	18370	SC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942368279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWCOUNTRY PLASTIC SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1205 TWO ISLAND CT
Second Line	:	SUITE 203
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7406
Country	:	US
Telephone Number	:	843-971-2860
Fax Number	:	843-971-0660

Provider Business Practice Location Address
First Line	:	1205 TWO ISLAND CT
Second Line	:	SUITE 203
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7406
Country	:	US
Telephone Number	:	843-971-2860
Fax Number	:	843-971-0660

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MICHELE HENSEL
Credential	:
Telephone Number	:	843-971-2860

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	01/08/2015

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