Healthcare Provider Details

I. General information

NPI: 1780076885
Provider Name (Legal Business Name): MURRELLS INLET ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 HIGHWAY 17 BYPASS
MURRELLS INLET SC
29576
US

IV. Provider business mailing address

3545 HIGHWAY 17 BYPASS
MURRELLS INLET SC
29576
US

V. Phone/Fax

Practice location:
  • Phone: 843-299-1717
  • Fax:
Mailing address:
  • Phone: 843-299-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TRACEY TYLICKI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 843-299-1717