Healthcare Provider Details

I. General information

NPI: 1437322542
Provider Name (Legal Business Name): FORT SUMTER SURGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 HOSPITAL DR SUITE A
MT PLEASANT SC
29464-3251
US

IV. Provider business mailing address

1230 HOSPITAL DR SUITE A
MT PLEASANT SC
29464-3251
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-4673
  • Fax: 843-971-3355
Mailing address:
  • Phone: 843-971-4673
  • Fax: 843-971-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27394
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number27394
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number27394
License Number StateSC

VIII. Authorized Official

Name: DR. WILLIAM H LYNCH
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 843-971-4673