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General NPI Number Information
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NPI Number | 1629966460
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Entity Type | Organization
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Legal Business Name | CHARLESTON SURGICAL CONSULTANTS, LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2850 TRICOM ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9192
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Country | US
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Telephone | 843-863-1188
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Fax | 843-863-8286
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Provider Business Mailing Address
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Address Line | 2850 TRICOM ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9192
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Country | US
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Telephone | 843-863-1188
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Fax | 843-863-8286
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH L RUSSELL
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Credential | MD
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Telephone | 843-863-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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