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NPI Code Detail

MEDICARE: SWEETGRASS PLASTIC SURGERY LLC

MEDICARE: SWEETGRASS PLASTIC SURGERY 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
12086S0122XPlastic and Reconstructive Surgery PhysicianMD28924SC

General Provider Information

NPI Number : 1972917680
Entity Type Code : Organization
Provider Name (Legal Business Name) : SWEETGRASS PLASTIC SURGERY LLC
Provider Business Mailing Address
First Line : 102 W 8TH NORTH ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-6656
Country : US
Telephone Number : 843-471-1135
Fax Number :
Provider Business Practice Location Address
First Line : 102 W 8TH NORTH ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-6656
Country : US
Telephone Number : 843-471-1135
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DENNIS K SCHIMPF
Credential : M.D.
Telephone Number : 843-471-1135
Provider Enumeration Date : 06/20/2014
Last Update Date : 12/04/2014

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Directions to “SWEETGRASS PLASTIC SURGERY LLC ” Practice Location

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