NPIMap

Organization Active NPI

Carolina Surgical Clinic, LLC

  • Clinic/Center
  • Newberry, SC
National Provider Identifier
1992830632
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
28906 Issued in SC
Legal business name
CAROLINA SURGICAL CLINIC, LLC
Practice address
2541 Evans St
Suite 100
Newberry, SC 29108-2963
Phone
(803) 276-1866
Fax
(803) 276-1867
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Authorized official

Name
Dr. Kevin W Davis, MDNPI 1194711283
Title
Owner Operator
Phone
(803) 276-1866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 28906 SC Primary

Addresses

Primary practice location

2541 Evans St
Suite 100
Newberry, SC 29108-2963

Mailing address

2541 Evans St
Suite 100
Newberry, SC 29108-2963
Phone (803) 276-1866

Other identifiers 2

IdentifierTypeStateIssuer
289066MedicaidSC
1194711283OtherNPI #

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1992830632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2541 EVANS ST",
            "address_2": "SUITE 100",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082963",
            "telephone_number": "803-276-1866",
            "fax_number": "803-276-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2541 EVANS ST",
            "address_2": "SUITE 100",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082963",
            "telephone_number": "803-276-1866",
            "fax_number": "803-276-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA SURGICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER  OPERATOR",
        "authorized_official_telephone_number": "803-276-1866",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": "28906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289066",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1194711283",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newberry, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.