MEDICARE: WEST ASHLEY COLONOSCOPY CENTER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1760841035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST ASHLEY COLONOSCOPY CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1178
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-1178
Country	:	US
Telephone Number	:	843-556-1285
Fax Number	:	843-556-1286

Provider Business Practice Location Address
First Line	:	1616 ASHLEY RIVER RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5902
Country	:	US
Telephone Number	:	843-556-1285
Fax Number	:	843-556-1286

Authorized Official
Title or Position	:	OWNER
Name	:	CHAD HUDSON
Credential	:
Telephone Number	:	843-556-1285

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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