Healthcare Provider Details

I. General information

NPI: 1639548779
Provider Name (Legal Business Name): MOYD SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E CAROLINA AVE
HARTSVILLE SC
29550-4312
US

IV. Provider business mailing address

528 E CAROLINA AVE
HARTSVILLE SC
29550-4312
US

V. Phone/Fax

Practice location:
  • Phone: 843-332-5111
  • Fax: 843-383-8991
Mailing address:
  • Phone: 843-332-5111
  • Fax: 843-383-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NISSA GAINEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-332-5111