Healthcare Provider Details

I. General information

NPI: 1770009995
Provider Name (Legal Business Name): LOW COUNTRY SURGICAL ASSISTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 HEARTHSTONE DR
RIDGELAND SC
29936-7088
US

IV. Provider business mailing address

PO BOX 1460
HARDEEVILLE SC
29927-1460
US

V. Phone/Fax

Practice location:
  • Phone: 352-585-5581
  • Fax:
Mailing address:
  • Phone: 352-585-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DESOUSA
Title or Position: OWNER
Credential:
Phone: 352-585-5581