MEDICARE: CAROLINA REGIONAL SURGERY CENTER. LTD

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	ASF069	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275596264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA REGIONAL SURGERY CENTER. LTD

Provider Business Mailing Address
First Line	:	1021 MEDICAL CIR
Second Line	:	SUITE 100
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4618
Country	:	US
Telephone Number	:	843-449-7885
Fax Number	:	843-497-5137

Provider Business Practice Location Address
First Line	:	1021 MEDICAL CIR
Second Line	:	SUITE 100
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4618
Country	:	US
Telephone Number	:	843-449-7885
Fax Number	:	843-497-5137

Authorized Official
Title or Position	:	VP
Name	:	WILLIAM GREGORY SWINNEY
Credential	:
Telephone Number	:	972-789-2877

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/15/2018

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