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Physicians Surgery Vascular Surgery

Provider NPI: 1104899145

Organization Information:
Organization is Subpart

Practice Location:
Tel: 843-664-0221  Fax: 843-664-9545

Business Mailing Address:
PO BOX 3239  FLORENCE, SC 29502-3239 US
Tel: 843-664-0221  Fax: 843-664-9545

NPI Information:
NPI: 1104899145
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Vascular Surgery
N363AS0400XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Thoracic Surgery (Cardiothoracic Vascular Surgery)

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 208G00000X





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