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General NPI Number Information
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NPI Number | 1306908926
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Entity Type | Organization
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Legal Business Name | PREMIER SURGICAL GROUP, LLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 3019 FARROW RD
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City | COLUMBIA
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State | SC
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Zip | 29203-7001
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Country | US
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Telephone | 803-779-3222
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Fax | 803-779-3223
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | COLUMBIA
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State | SC
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Zip | 29202-0062
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Country | US
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Telephone | 803-779-3222
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Fax | 803-779-3223
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Authorized Official
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Title or Position | OWNER
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Name | KAYLENE WEIRCOX
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Credential | M.D.
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Telephone | 803-779-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 26856
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License Number State | SC
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