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General NPI Number Information
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NPI Number | 1124026422
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Entity Type | Organization
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Legal Business Name | CHARLESTON ENT ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 1849 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 803-766-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 2295 HENRY TECKLENBURG DR.
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City | CHARLESTON
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State | SC
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Zip | 29414-7801
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Country | US
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Telephone | 803-766-7103
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Fax | 843-576-2592
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. CHARLENE THOMPSON
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Credential |
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Telephone | 843-763-5342
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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 | ASF072
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License Number State | SC
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