Healthcare Provider Details

I. General information

NPI: 1356750780
Provider Name (Legal Business Name): SOUTHERN CAROLINA SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK DR BLDG 4, SUITE A
CHESTER SC
29706-9769
US

IV. Provider business mailing address

102 REEDY ST
CHESTER SC
29706-1836
US

V. Phone/Fax

Practice location:
  • Phone: 803-581-2001
  • Fax: 803-581-2892
Mailing address:
  • Phone: 803-581-2001
  • Fax: 803-581-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23667
License Number StateSC

VIII. Authorized Official

Name: DR. MICHAEL LLOYD HUGHES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-374-6409