Healthcare Provider Details

I. General information

NPI: 1629002654
Provider Name (Legal Business Name): COMPLETE COLON CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR SUITE 307 EAST
CHARLESTON SC
29414-5744
US

IV. Provider business mailing address

2093 HENRY TECKLENBURG DR SUITE 307 EAST
CHARLESTON SC
29414-5744
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-3592
  • Fax: 843-763-4171
Mailing address:
  • Phone: 843-763-3592
  • Fax: 843-763-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LAHR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-763-3592