Organization
PRO SOMA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN J WARD CRNA (PRESIDENT)
(843) 992-4627
Entity
Organization
Contact information
Practice address
3330 EBENEZER CHASE DR, FLORENCE, SC 29501-8006
(843) 992-4627
Mailing address
PO BOX 7024, FLORENCE, SC 29502-7024
(843) 992-4627
(843) 669-6116
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3617
—
SC
Enumeration date
05/17/2007
Last updated
08/22/2020
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