Organization
PENINSULA ENT AND PLASTIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NATAHSA F GLENCAMP (BILLING SPECIALIST)
(843) 958-8877
Entity
Organization
Contact information
Practice address
125 DOUGHTY ST, SUITE 440, CHARLESTON, SC 29403-5736
(843) 958-8877
(843) 958-8878
Mailing address
125 DOUGHTY ST, SUITE 440, CHARLESTON, SC 29403-5736
(843) 958-8877
(843) 958-8878
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12840
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128409
—
SC
Enumeration date
01/19/2006
Last updated
09/26/2007
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