=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407838063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH CAROLINA MEDICAL ENDOSCOPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2005
-----------------------------------------------------
Last Update Date | 11/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2631 FOREST DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-254-8449
-----------------------------------------------------
Fax | 803-254-8984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2631 FOREST DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-254-8449
-----------------------------------------------------
Fax | 803-254-8984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. STEPHEN C LLOYD
-----------------------------------------------------
Credential | M.D., PH.D.
-----------------------------------------------------
Telephone | 803-254-8449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | ASF-042
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------