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General NPI Number Information
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NPI Number | 1376674143
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Entity Type | Organization
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Legal Business Name | COVENANT SURGICAL CARE LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 400 PLAZA CIR STE H
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City | CLINTON
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State | SC
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Zip | 29325-7558
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Country | US
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Telephone | 864-833-4166
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Fax | 864-833-5668
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Provider Business Mailing Address
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Address Line | PO BOX 120
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City | CLINTON
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State | SC
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Zip | 29325-0120
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Country | US
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Telephone | 864-833-4166
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Fax | 864-833-5668
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Authorized Official
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Title or Position | PRESIDENT
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Name | B SHARON MURRAY
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Credential | MD
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Telephone | 864-833-4166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 27503
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License Number State | SC
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