# COASTAL CAROLINA CENTERS OF UROLOGY AND SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rivertown Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205095080
- **Authorized official:** MRS. VIRGINIA A MCCURDY (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (843) 347-9587

## Contact information

- **Practice address:** 822 FARRAR DR, CONWAY, SC 29526-8747
- **Practice address phone:** (843) 347-9587
- **Mailing address:** 822 FARRAR DR, CONWAY, SC 29526-8747
- **Mailing address phone:** (843) 347-9587

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/05/2008
- **Last updated:** 06/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP4062 | — | SC |