Healthcare Provider Details

I. General information

NPI: 1376528950
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF CHARLESTON, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ALBEMARLE RD
CHARLESTON SC
29407-7540
US

IV. Provider business mailing address

510 ALBEMARLE RD
CHARLESTON SC
29407-7540
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-6426
  • Fax: 843-722-2193
Mailing address:
  • Phone: 843-723-6426
  • Fax: 843-722-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7706
License Number StateSC

VIII. Authorized Official

Name: MRS. LORRAINE VERONICA TYLER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 843-723-6426