Healthcare Provider Details

I. General information

NPI: 1407838063
Provider Name (Legal Business Name): SOUTH CAROLINA MEDICAL ENDOSCOPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 FOREST DR
COLUMBIA SC
29204-2363
US

IV. Provider business mailing address

2631 FOREST DR
COLUMBIA SC
29204-2363
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-8449
  • Fax: 803-254-8984
Mailing address:
  • Phone: 803-254-8449
  • Fax: 803-254-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberASF-042
License Number StateSC

VIII. Authorized Official

Name: DR. STEPHEN C LLOYD
Title or Position: MEDICAL DIRECTOR
Credential: M.D., PH.D.
Phone: 803-254-8449