SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC (NPI# 1477628725) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477628725 |
| Entity Type | Organization |
| Organization Name | SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC |
| Other Organization Name | SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC |
| Practice Address |
136 Professional Park Drive Clinton SC 29325 |
| Practice Telephone | 8649389836 |
| Practice Fax Number | 8649389838 |
| Mailing Telephone | 8649389836 |
| Mailing Fax Number | 8649389838 |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2015-03-30 |
| Authorized Official Name | DR. SAMUEL JACOB MONTGOMERY (OWNER/MEMBER) |
| Authorized Official Telephone | 8649389836 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
SC | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Surgery & Laser Center at Professional Park LLC | Doing Business As Name - Organization |
| Street Address |
136 PROFESSIONAL PARK DRIVE |
| City | CLINTON |
| State | SC |
| Zip Code | 29325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295353100 | Mason Paige Gambrell | Student in an Organized Health Care Education/Training Program | 107 Shellcreek Ct, Clinton, SC 29325 | 2020-07-07 |
| 1386207975 | Tammy Binger | Registered Nurse | 22725 U.S. 76, Clinton, SC 29325 | 2019-04-18 |
| 1154828945 | Lillian Smith | Physical Therapy Assistant | Nhc Clinton, 304 Jacobs Highway, Clinton, SC 29325 | 2018-04-09 |
| 1134519366 | Nora Pace | Specialist/Technologist | 18132 Hwy 72 E, Clinton, SC 29325 | 2015-01-26 |
| 1497186845 | John M. Griz | Orthopaedic Surgery | 22971 Hwy 76e, Clinton, SC 29325 | 2013-12-11 |
| 1992131171 | Sharon Kay Stoia | Occupational Therapist | 600 Plaza Circle, Clinton, SC 29325 | 2013-09-19 |
| 1578800256 | Hayes Ambulance Service LLC | Ambulance | 2143 Torrington Road, Clinton, SC 29325 | 2013-01-14 |
| 1083943518 | Margaret Estelle Shreve | Chiropractor | 209 Musgrove St, Clinton, SC 29325 | 2009-12-11 |
| 1750556213 | Piedmont Regional Urology | Urology | 300 Plantation Plaza, Suite F, Clinton, SC 29325 | 2008-04-25 |
| 1285821587 | Assisted Living Concepts Inc | Assisted Living Facility | 939 Springdale Drive, Clinton, SC 29325 | 2007-10-01 |
| Find all providers in zip 29325 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396919783 | Surgcenter of Southern Maryland, LLC | Clinic/Center | 9001 Woodyard Rd, Clinton, MD 20735-4205 | 2008-04-16 |
| 1881651206 | Gateway Surgery Center, L.L.C. | Clinic/Center | 841 Springdale Dr, Clinton, IA 52732-3579 | 2006-04-28 |
| 1386624815 | Quality Surgicenter LLC | Clinic/Center | 2745 Lincolnway, Clinton, IA 52732-7201 | 2006-01-19 |
| 1629218466 | Olympian Surgical Suites LLC | Clinic/Center | 803 Illini Dr, Clinton, IL 61727 | 2009-03-05 |
| 1770551517 | Southern Maryland Endoscopy Center | Clinic/Center | 7700 Old Branch Ave, Suite A102, Clinton, MD 20735-1628 | 2006-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194344606 | Tidelands Health Asc LLC | Clinic/Center | 2200 Crow Ln Ste 102, Myrtle Beach, SC 29577-1663 | 2020-04-14 |
| 1528602455 | Cornerstone Surgery Centers, LLC | Clinic/Center | 3911 Highway 17 Ste B, Murrells Inlet, SC 29576-5014 | 2019-11-04 |
| 1598227431 | Surgery Center of Conway Inc | Clinic/Center | 1405 Main Street, Conway, SC 29526 | 2019-04-01 |
| 1265999197 | Medical University Hospital Authority | Clinic/Center | 1580 Freedom Blvd Ste 300, Florence, SC 29505-6074 | 2019-02-27 |
| 1194233189 | Chapin Orthopedic Surgery Center | Clinic/Center | 106 Ellett Road, Chapin, SC 29036-8248 | 2018-01-12 |
| 1124547617 | Southeastern Anesthesia Associates, LLC | Clinic/Center | 1 Wellness Blvd Ste 111, Irmo, SC 29063-2873 | 2017-09-15 |
| 1518338052 | Center for Advanced Surgery LLC | Clinic/Center | 3821 Commercial Center Drive, Ladson, SC 29456-4146 | 2015-10-09 |
| 1881094894 | Center for Colon and Digestive Diseases LLC | Clinic/Center | 103 Gregg Ave Nw, Suite 100, Aiken, SC 29801-6357 | 2014-08-27 |
| 1578986550 | Summerville Endoscopy Center, LLC | Clinic/Center | 328 Midland Pkwy, Summerville, SC 29485-8102 | 2014-01-28 |
| 1295176139 | Lowcountry Ambulatory Center, LLC | Clinic/Center | 1844 Wallace School Rd, Charleston, SC 29407-4822 | 2013-07-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.