Healthcare Provider Details

I. General information

NPI: 1417928268
Provider Name (Legal Business Name): LOW COUNTRY ANESTHESIA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 RIBAUT ROAD
BEAUFORT SC
29902
US

IV. Provider business mailing address

PO BOX 74
COLUMBIA SC
29202
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-5087
  • Fax: 843-522-5007
Mailing address:
  • Phone: 803-765-1838
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY A THOMPSON
Title or Position: PRESIDENT
Credential:
Phone: 843-522-5087