Organization
BAY MICROSURGICAL UNIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD E TILLER M.D. (OWNER)
(843) 546-8421
Entity
Organization
Contact information
Practice address
1200 HIGHMARKET ST, STE 100, GEORGETOWN, SC 29440-3227
(843) 546-8421
(843) 546-1173
Mailing address
PO BOX 2900, GEORGETOWN, SC 29442-2900
(843) 546-8421
(843) 546-1173
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASF090
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410059
—
SC
Enumeration date
08/31/2006
Last updated
10/23/2007
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