Healthcare Provider Details

I. General information

NPI: 1043846595
Provider Name (Legal Business Name): VIP COSMETIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WILLIAM POPE DR STE 4
BLUFFTON SC
29909-7550
US

IV. Provider business mailing address

10 WILLIAM POPE DR STE 4
BLUFFTON SC
29909-7550
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-1515
  • Fax: 843-705-1512
Mailing address:
  • Phone: 843-705-1515
  • Fax: 843-705-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA NICHOLS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 843-705-1515