Healthcare Provider Details

I. General information

NPI: 1942575451
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF WACCAMAW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4367 RIVERWOOD DRIVE SUITE 130
MURRELLS INLET SC
29440
US

IV. Provider business mailing address

4367 RIVERWOOD DRIVE SUITE 130
MURRELLS INLET SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-8390
  • Fax: 843-652-8399
Mailing address:
  • Phone: 843-652-8390
  • Fax: 843-652-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26036
License Number StateSC

VIII. Authorized Official

Name: DR. MATTHEW J METZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 843-652-8390