Organization
YORK COUNTY ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN BOTT MD (MEDICAL DIRECTOR)
(803) 325-9010
Entity
Organization
Contact information
Practice address
164 GLENWOOD DRIVE, ROCK HILL, SC 29732-2865
(803) 325-9010
(803) 325-9015
Mailing address
164 GLENWOOD DRIVE, ROCK HILL, SC 29732-2865
(803) 325-9010
(803) 325-9015
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASF-0113
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42C0001 080
CCN
SC
01
—
42D1098380
MEDICARE CLIA WAIVER
—
01
—
75-12730
SC DHEC
SC
01
—
ASF0113
SC DHEC
SC
01
—
Q351120001
MEDICARE PTAN
—
Enumeration date
03/26/2009
Last updated
03/07/2023
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