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General NPI Number Information
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NPI Number | 1992776371
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Entity Type | Organization
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Legal Business Name | KEOWEE SURGICAL CLINIC P.A.
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 LEA'S COURTYARD CLIFFABEE LEA'S
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City | SENECA
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State | SC
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Zip | 29679
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Country | US
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Telephone | 864-882-5722
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Fax | 864-882-5739
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Provider Business Mailing Address
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Address Line | PO BOX 946 2 LEA'S COURTYARD
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City | SENECA
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State | SC
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Zip | 29679-0946
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Country | US
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Telephone | 864-882-5722
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Fax | 864-882-5739
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. HELEN MARTIN
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Credential |
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Telephone | 864-882-5722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 17825
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License Number State | SC
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