Waccamaw Surgical Associates

Primary specialty

SpecialistTaxonomy code 174400000X

License

14277 Issued in SC

Legal business name

WACCAMAW SURGICAL ASSOCIATES

Practice address

401 Marina Dr
Georgetown, SC 29440-2410

Phone

(843) 546-7272

Fax

(843) 546-0277

NPI assigned

Feb 20, 2007

Last updated

Jun 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Terry Lentz Fry, MDNPI 1104873017

Title

Owner

Phone

(843) 546-7272

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terry L Fry, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Georgetown, SC
  • NPI 1104873017
  Medicare reassignment NPD Authorized official
• Karen K Perry, HIS

  • Hearing Instrument Specialist
  • Georgetown, SC
  • NPI 1619765419
  NPD

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1710022660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MARINA DR",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402410",
            "telephone_number": "843-546-7272",
            "fax_number": "843-546-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MARINA DR",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402410",
            "telephone_number": "843-546-7272",
            "fax_number": "843-546-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "FRY",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "LENTZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-546-7272",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "14277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14277",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Waccamaw Hearing Specialist
• Waccamaw Kidney & Hypertension Specialists,P.a.
• Waccamaw Nutrition (Bite Into Wellness)
• Waccamaw Oncology Physicians, LLC
• Waccamaw Oncology, PA
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0625)
• Wal-Mart Stores East, LP. (Walmart Vision Center 30-0625)
• Walgreen Co (Rite Aid #17121)
• Walgreen Co (Walgreens #09834)
• Ketwanna Latoiya Walker

• Specialist in Georgetown, SC
• Providers in Georgetown, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.