Basic Information
| Provider Information | |||||||||
| NPI: | 1811975253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL ASSOCIATES OF SOUTH CAROLINA P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7728 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292027728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032563400 | ||||||||
| FaxNumber: | 8032562039 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 LAUREL ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032563400 | ||||||||
| FaxNumber: | 8032562039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SWEATMAN | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | ALDEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8032563400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. F.A.C.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | PA2498 | 05 | SC | MEDICAID |