Organization Name: | COLLETON AMBULATORY CARE, LLC |
NPI Number: | 1114957891 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DERON SMITH (ADMINISTRATOR) |
Mailing Address: | 304 Medical Park Dr Walterboro |
State: | SC US |
Postal Code: | 294885743 |
Phone Number: | 8437822700 |
Fax Number: | 8437822701 |
NPI Enumeration Date: | 07/05/2006 |
NPI Last Update Date: | 05/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | ASF-035 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |