Basic Information
| Provider Information | |||||||||
| NPI: | 1770537698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS SURGERY CENTER OF FLORENCE LLC | ||||||||
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| OtherOrganizationName: | PHYSICIANS SURGERY CENTER OF FLORENCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 849814 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436643300 | ||||||||
| FaxNumber: | 8436643723 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 FREEDOM BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295056074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436643300 | ||||||||
| FaxNumber: | 8436643723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HURLEY | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2144737000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | ASF-088 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | ASC057 | 05 | SC | MEDICAID |