Healthcare Provider Details

I. General information

NPI: 1265696439
Provider Name (Legal Business Name): ST. ANDREWS SURGICAL ASSOC. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 OLD CHAPIN RD
LEXINGTON SC
29072-9549
US

IV. Provider business mailing address

1006 OLD CHAPIN RD
LEXINGTON SC
29072-9549
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-7434
  • Fax:
Mailing address:
  • Phone: 803-359-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD5755
License Number StateSC

VIII. Authorized Official

Name: DR. FREDERICK WAYNE CLEMENZ
Title or Position: OWNER
Credential: M.D.
Phone: 803-359-7434