Basic Information
| Provider Information | |||||||||
| NPI: | 1821066200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOWCOUNTRY OUTPATIENT SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 93A SPRINGVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432856060 | ||||||||
| FaxNumber: | 8437973633 | ||||||||
| Practice Location | |||||||||
| Address1: | 93A SPRINGVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432856060 | ||||||||
| FaxNumber: | 8437973633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 10/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCGUISTON | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 8432856069 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 23410 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 20044504 | 01 | SC | SELECT HEALTH | OTHER | 461555 | 05 | SC | MEDICAID | 10025310500 | 05 | NE | MEDICAID | ASC060 | 05 | SC | MEDICAID | P00210673 | 01 | SC | RAIL RD MEDICARE | OTHER |