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General NPI Number Information
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NPI Number | 1760888127
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Entity Type | Organization
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Legal Business Name | SEASIDE PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 25 SHERINGTON PARK DRIVE SUITE D-1
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City | BLUFFTON
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State | SC
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Zip | 29910
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Country | US
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Telephone | 843-757-5559
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Fax | 843-757-5546
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Provider Business Mailing Address
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Address Line | 25 SHERINGTON PARK DRIVE SUITE D-1
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City | BLUFFTON
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State | SC
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Zip | 29910
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Country | US
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Telephone | 843-757-5559
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Fax | 843-757-5546
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ROWE
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Credential | MD
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Telephone | 843-757-5559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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