MEDICARE: SOUTH CAROLINA MEDICAL ENDOSCOPY, INC.

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	261QE0800X	Endoscopy Clinic/Center	ASF-042	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	:	1407838063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA MEDICAL ENDOSCOPY, INC.

Provider Business Mailing Address
First Line	:	2631 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2363
Country	:	US
Telephone Number	:	803-254-8449
Fax Number	:	803-254-8984

Provider Business Practice Location Address
First Line	:	2631 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2363
Country	:	US
Telephone Number	:	803-254-8449
Fax Number	:	803-254-8984

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. STEPHEN C LLOYD
Credential	:	M.D., PH.D.
Telephone Number	:	803-254-8449

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/13/2014

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