Healthcare Provider Details

I. General information

NPI: 1740466457
Provider Name (Legal Business Name): ENDOSCOPY ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LINER DR
GREENWOOD SC
29646-2311
US

IV. Provider business mailing address

103 LINER DR
GREENWOOD SC
29646-2311
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-3636
  • Fax: 864-396-2245
Mailing address:
  • Phone: 864-227-3636
  • Fax: 864-396-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number11102
License Number StateSC

VIII. Authorized Official

Name: ALBERT A RAMAGE III
Title or Position: PARTNER
Credential: MD
Phone: 864-227-3636