=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427044452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SURGERY CENTER AT SELF MEMORIAL HOSPITAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2005
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ACADEMY AVE
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646-3869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-725-7500
-----------------------------------------------------
Fax | 864-725-7501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 ACADEMY AVE
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29646-3869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-725-7500
-----------------------------------------------------
Fax | 864-725-7501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. VALARIE PRICE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 864-725-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | ASF055
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------