Provider Demographics
NPI:1538164546
Name:SURGERY CENTER AT PELHAM, LLC
Entity type:Organization
Organization Name:SURGERY CENTER AT PELHAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-560-5555
Mailing Address - Street 1:13740 CYPRESS TERRACE CIR
Mailing Address - Street 2:STE 501-503
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8827
Mailing Address - Country:US
Mailing Address - Phone:239-274-1000
Mailing Address - Fax:239-274-1001
Practice Address - Street 1:2755 S HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4926
Practice Address - Country:US
Practice Address - Phone:864-560-5555
Practice Address - Fax:864-560-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-091261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical