Healthcare Provider Details

I. General information

NPI: 1629966460
Provider Name (Legal Business Name): CHARLESTON SURGICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TRICOM ST
NORTH CHARLESTON SC
29406-9192
US

IV. Provider business mailing address

2850 TRICOM ST
NORTH CHARLESTON SC
29406-9192
US

V. Phone/Fax

Practice location:
  • Phone: 843-863-1188
  • Fax: 843-863-8286
Mailing address:
  • Phone: 843-863-1188
  • Fax: 843-863-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH L RUSSELL
Title or Position: OWNER
Credential: MD
Phone: 843-863-1188