Healthcare Provider Details

I. General information

NPI: 1487765897
Provider Name (Legal Business Name): BAY MICROSURGICAL UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HIGHMARKET ST STE 100
GEORGETOWN SC
29440-3227
US

IV. Provider business mailing address

PO BOX 2900
GEORGETOWN SC
29442-2900
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-8421
  • Fax: 843-546-1173
Mailing address:
  • Phone: 843-546-8421
  • Fax: 843-546-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF090
License Number StateSC

VIII. Authorized Official

Name: GERALD E TILLER
Title or Position: OWNER
Credential: M.D.
Phone: 843-546-8421