| Organization Name: | PROVIDENT HEALTH SURGICAL ASSOCIATES, INC. |
| NPI Number: | 1083862882 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR) |
| Mailing Address: | 14 Okatie Center Blvd. South Suite 101 Okatie |
| State: | SC US |
| Postal Code: | 29909 |
| Phone Number: | 9123502299 |
| Fax Number: | 9123502298 |
| NPI Enumeration Date: | 09/04/2008 |
| NPI Last Update Date: | 05/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0201X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Gynecologic Oncology |
| Taxonomy Definition: | An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |