Healthcare Provider Details

I. General information

NPI: 1861073371
Provider Name (Legal Business Name): PALMETTO ENDOSCOPY CENTER - MT PLEASANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WIRE GRASS DRIVE
MT PLEASANT SC
29466
US

IV. Provider business mailing address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-0643
  • Fax: 843-571-0311
Mailing address:
  • Phone: 843-571-0643
  • Fax: 843-571-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONYA M WYATT
Title or Position: CEO
Credential:
Phone: 843-571-0643