# CCLC OBS LLC

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

## Provider details

- **NPI number:** 1780425330
- **Authorized official:** ANNE PARKER (MEDICAL DIRECTOR)
- **Authorized official phone:** (864) 286-3700

## Contact information

- **Practice address:** 121 HALTON VILLAGE CIR, GREENVILLE, SC 29607-6825
- **Practice address phone:** (864) 286-3700
- **Mailing address:** 121 HALTON VILLAGE CIR, GREENVILLE, SC 29607-6825
- **Mailing address phone:** (864) 286-3700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |
| 261QS0132X | Ophthalmologic Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/05/2024
- **Last updated:** 06/05/2024