Surgery & Laser Center at Professional Park LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC

Practice address

136 Professional Park Rd
Clinton, SC 29325-7529

Phone

(864) 938-9836

NPI assigned

Nov 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Becker

Title

Cfo

Phone

(914) 391-4921

Specialties & licenses 1

Addresses

Other names 1

• Surgery & Laser Center at Professional Park LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Listed as

Surgery and Laser Center at Professional Park LLCCCN 42C0001070

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel Jacob Montgomery Jr., M.D.

  • Ophthalmology Physician
  • Clinton, SC
  • NPI 1467488551
  NPD
• Harvard Keith Riddle Jr., M.D.

  • Ophthalmology Physician
  • Clinton, SC
  • NPI 1134155955
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777334400000",
    "number": "1477628725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352468575",
            "telephone_number": "864-359-1308",
            "fax_number": "239-496-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 PROFESSIONAL PARK RD",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "293257529",
            "telephone_number": "864-938-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY & LASER CENTER AT PROFESSIONAL PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "914-391-4921"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgery & Laser Center at Professional Park LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Stone, BS, ADC
• Donna K. Stover, R.N.
• Tamara Jill Strike-Nelson, OTR,L
• Edith Ann Stull, RPH
• Savannah Rose Styles
• Susan Marsh Swindell, M.S., CCC-SLP
• Lenora Talley, LMSW
• Nancy Annetta Taylor, PHARMACIST
• The Family Healthcare Center
• The Family Medical Ctr of Clinton Inc

• Ambulatory Surgical Clinic/Center in Clinton, SC
• Providers in Clinton, SC by specialty
• Ambulatory Surgical Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.