Healthcare Provider Details

I. General information

NPI: 1285145037
Provider Name (Legal Business Name): ULM CENTER FOR PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 TRICOM ST
NORTH CHARLESTON SC
29406-9172
US

IV. Provider business mailing address

777 POST OAK DR
MT PLEASANT SC
29464-4953
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON ULM
Title or Position: OWNER
Credential: MD
Phone: 317-847-8410