Organization
COLUMBIA ASC NORTHWEST LLC
Active
Other names
Lake Murray Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
190 PARKRIDGE DR, SUITE 100, COLUMBIA, SC 29212-1747
(803) 407-6767
(803) 407-6757
Mailing address
1A BURTON HILLS BLVD, ATTN: L&C, NASHVILLE, TN 37215-6103
(803) 407-6767
(803) 407-6757
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASF-076
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ASC048
—
SC
Enumeration date
02/13/2006
Last updated
09/07/2023
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