# IPS OF SOUTH CAROLINA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225350564
- **Authorized official:** DR. CARL R NOBACK MD (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (941) 360-1566

## Contact information

- **Practice address:** 2536 LENGERS WAY, FORT MILL, SC 29707-7126
- **Practice address phone:** (803) 802-9500
- **Practice address fax:** (803) 802-8499
- **Mailing address:** PO BOX 864483, ORLANDO, FL 32886-0001
- **Mailing address phone:** (941) 360-1566
- **Mailing address fax:** (941) 358-9818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 02/26/2010
- **Last updated:** 02/26/2010