Healthcare Provider Details

I. General information

NPI: 1508840893
Provider Name (Legal Business Name): PARKWAY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

827 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 843-286-2020
  • Fax:
Mailing address:
  • Phone: 843-286-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF-061
License Number StateSC

VII. Legacy identifiers

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

# 1
IdentifierASCO34
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MRS. DEBBIE BOSLEY
Title or Position: FINANCIAL COORDINATOR
Credential:
Phone: 843-449-1010