MEDICARE: ATLANTIC 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
1	261QA1903X	Ambulatory Surgical Clinic/Center	ASF-085	SC

General Provider Information

NPI Number	:	1790852994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	3911 HIGHWAY 17 BYPASS
Second Line	:	SUITE B
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5014
Country	:	US
Telephone Number	:	843-651-8211
Fax Number	:	843-651-8882

Provider Business Practice Location Address
First Line	:	3911 HIGHWAY 17
Second Line	:	SUITE B
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5014
Country	:	US
Telephone Number	:	843-651-8211
Fax Number	:	843-651-8882

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JONATHAN J PLY
Credential	:	M.D.
Telephone Number	:	843-651-8211

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	08/22/2020

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