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General NPI Number Information
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NPI Number | 1932274743
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA CENTERS OF UROLOGY AND SURGERY LLC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 822 FARRAR DRIVE
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City | CONWAY
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State | SC
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Zip | 29526-8747
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Country | US
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Telephone | 843-347-9587
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Fax | 843-347-9633
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Provider Business Mailing Address
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Address Line | 822 FARRAR DR
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City | CONWAY
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State | SC
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Zip | 29526-8747
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Country | US
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Telephone | 843-347-9587
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Fax | 843-347-9633
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. VIRGINIA A MCCURDY
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Credential |
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Telephone | 843-347-9587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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