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General NPI Number Information
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NPI Number | 1073505038
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Entity Type | Organization
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Legal Business Name | PALMETTO SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 109 BLARNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29223-6244
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Country | US
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Telephone | 803-865-8200
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Fax | 803-419-7910
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Provider Business Mailing Address
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Address Line | 109 BLARNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29223-6244
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Country | US
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Telephone | 803-865-8200
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Fax | 803-419-7910
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | ALAN BRILL
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Credential | M.D.
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Telephone | 803-865-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASF 046
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License Number State | SC
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