Healthcare Provider Details

I. General information

NPI: 1972576536
Provider Name (Legal Business Name): CSC ACQUISITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FOREST DR STE 400
COLUMBIA SC
29204-4057
US

IV. Provider business mailing address

3600 FOREST DR STE 400
COLUMBIA SC
29204-4057
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-7316
  • Fax: 803-343-2538
Mailing address:
  • Phone: 803-779-7316
  • Fax: 803-343-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JIM C CHOW
Title or Position: PARTNER
Credential: MD
Phone: 803-779-7316