Organization
TRI-COUNTY SURGERY, LLC
Active
Other names
Loris Surgical Associates, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANE INGRAM MOORE M.D. (MANAGER)
(843) 756-5524
Entity
Organization
Contact information
Practice address
3327 CASEY ST, LORIS, SC 29569-2811
(843) 756-5524
Mailing address
3327 CASEY ST, LORIS, SC 29569-2811
(843) 756-5524
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8902028
—
SC
05
—
PA1462
—
SC
Enumeration date
01/05/2007
Last updated
08/22/2020
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