Healthcare Provider Details

I. General information

NPI: 1588316046
Provider Name (Legal Business Name): SEASIDE SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 HIGHWAY 78 BLDG 100
LADSON SC
29456-4118
US

IV. Provider business mailing address

9565 HIGHWAY 78 BLDG 100
LADSON SC
29456-4118
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-7615
  • Fax: 843-553-1008
Mailing address:
  • Phone: 843-553-7615
  • Fax: 843-553-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCES SANTIAGO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 843-548-7801