MEDICARE: BERKELEY ENDOSCOPY 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

General Provider Information

NPI Number	:	1841395621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	1072 WILDWOOD CENTRE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8420
Country	:	US
Telephone Number	:	803-788-1120
Fax Number	:	803-788-4522

Provider Business Practice Location Address
First Line	:	1072 WILDWOOD CENTRE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8420
Country	:	US
Telephone Number	:	803-788-1120
Fax Number	:	803-788-4522

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SIVA K CHOCKALINGAM
Credential	:	MD
Telephone Number	:	803-788-1120

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	10/22/2012

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