Provider Demographics
NPI:1386916450
Name:COLORECTAL SURGERY CLINIC, LLC
Entity type:Organization
Organization Name:COLORECTAL SURGERY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-853-7730
Mailing Address - Street 1:1439 STUART ENGALS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3686
Mailing Address - Country:US
Mailing Address - Phone:843-853-7730
Mailing Address - Fax:843-722-8766
Practice Address - Street 1:1439 STUART ENGALS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3686
Practice Address - Country:US
Practice Address - Phone:843-853-7730
Practice Address - Fax:843-722-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 28532208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty