MEDICARE: LOWCOUNTRY GASTROENTEROLOGY ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1073714713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWCOUNTRY GASTROENTEROLOGY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	1300 HOSPITAL DR
Second Line	:	SUITE 300
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3261
Country	:	US
Telephone Number	:	843-884-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 HOSPITAL DR
Second Line	:	SUITE 300
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3261
Country	:	US
Telephone Number	:	843-884-5200
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RENE B SEVERNS
Credential	:
Telephone Number	:	843-884-8500

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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