Basic Information
| Provider Information | |||||||||
| NPI: | 1477088250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANSFORMATIONS SKIN & BODY SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3769 SEA MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295667861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434675972 | ||||||||
| FaxNumber: | 8435078372 | ||||||||
| Practice Location | |||||||||
| Address1: | 3769 SEA MOUNTAIN HWY | ||||||||
| Address2: | |||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295667861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434675972 | ||||||||
| FaxNumber: | 8435078372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2017 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | QUIRKE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | EDMOND | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8434675972 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 21736 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.