Organization
SOUTHERN SURGERY SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS E MONTENEGRO MD (PRESIDENT)
(803) 943-4003
Entity
Organization
Contact information
Practice address
408 JACKSON AVE E, HAMPTON, SC 29924
(803) 943-4003
(803) 943-4701
Mailing address
PO BOX 1289, VARNVILLE, SC 29944
(803) 943-4003
(803) 943-4701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
23479
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588613103
PROVIDER NPI
—
05
—
234794
—
SC
Enumeration date
09/14/2006
Last updated
11/07/2008
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