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NPI Code Detail

MEDICARE: CAROLINA SURGERY CENTER LLC

MEDICARE: CAROLINA SURGERY CENTER 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
1367500000XCertified Registered Nurse Anesthetist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DR3018OTHERSCRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467770206
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINA SURGERY CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 1547
Second Line :
City : SEDALIA
State : MO
Zip : 65302-1547
Country : US
Telephone Number : 660-826-5960
Fax Number :
Provider Business Practice Location Address
First Line : 2536 LENGERS WAY
Second Line :
City : FORT MILL
State : SC
Zip : 29707-7126
Country : US
Telephone Number : 803-802-9500
Fax Number :
Authorized Official
Title or Position : CEO
Name : DOUG ARBOUR
Credential :
Telephone Number : 803-286-1481
Provider Enumeration Date : 05/04/2010
Last Update Date : 06/03/2011

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Directions to “CAROLINA SURGERY CENTER LLC ” Practice Location

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