MEDICARE: ANESTHESIA SC LLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1295271948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA SC LLC

Provider Business Mailing Address
First Line	:	PO BOX 1427
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-1427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SURGEONS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-5198
Country	:	US
Telephone Number	:	843-504-7194
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	RYAN WESLEY SMITH
Credential	:
Telephone Number	:	843-504-7194

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	10/06/2019

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