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Organization
IPS OF SOUTH CAROLINA LLC
Active
Organization
IPS OF SOUTH CAROLINA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL R NOBACK MD (AUTHORIZED OFFICIAL)
(941) 360-1566
Entity
Organization
Contact information
Practice address
2536 LENGERS WAY, FORT MILL, SC 29707-7126
(803) 802-9500
(803) 802-8499
Mailing address
PO BOX 864483, ORLANDO, FL 32886-0001
(941) 360-1566
(941) 358-9818
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
NULL
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
02/26/2010
Last updated
02/26/2010
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