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General NPI Number Information
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NPI Number | 1265696439
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Entity Type | Organization
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Legal Business Name | ST. ANDREWS SURGICAL ASSOC. PC
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 1006 OLD CHAPIN RD
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City | LEXINGTON
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State | SC
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Zip | 29072-9549
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Country | US
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Telephone | 803-359-7434
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 OLD CHAPIN RD
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City | LEXINGTON
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State | SC
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Zip | 29072-9549
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Country | US
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Telephone | 803-359-7434
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK WAYNE CLEMENZ
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Credential | M.D.
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Telephone | 803-359-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | MD5755
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License Number State | SC
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