TIDELANDS AND MEDQUEST JOINT VENTURE, LLC (NPI# 1083275366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083275366 |
| Entity Type | Organization |
| Organization Name | TIDELANDS AND MEDQUEST JOINT VENTURE, LLC |
| Other Organization Name | TIDELANDS HEALTH IMAGING |
| Practice Address |
900 21st Ave N Myrtle Beach SC 29577-7483 |
| Mailing Address |
606 Black River Rd Georgetown SC 29440-3304 |
| Practice Telephone | 8439161700 |
| Practice Fax Number | 8439169460 |
| Mailing Telephone | 8435277000 |
| Mailing Fax Number | 8436528032 |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-09-11 |
| Authorized Official Name | ELIZABETH S WARD (EVP & CFO) |
| Authorized Official Telephone | 8435277102 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities | ||
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| Other Name | Type Code |
|---|---|
| Tidelands Health Imaging | Doing Business As Name - Organization |
| Tidelands Health Imaging at Long Bay | Doing Business As Name - Organization |
| Street Address |
900 21ST AVE N |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29577-7483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124536446 | Well Care Home Health of The Lowcountry | Home Health | 1039 44th Ave N Ste 101, Myrtle Beach, SC 29577 | 2018-01-22 |
| 1518470913 | Guillot Enterprises, LLC | Hearing Instrument Specialist | 1294 Professional Dr., Suite C, Myrtle, SC 29577 | 2017-11-08 |
| 1598288227 | Ryan Shepherd | Pharmacist | 1705 South Kings Highway, Myrtle Beach, SC 29577 | 2017-07-25 |
| 1184176554 | Shannon Long | Counselor | 1293 Professional Drive, Suite D Office 222, Myrtle Beach, SC 29577 | 2016-11-01 |
| 1265898191 | Coastal Carolina Infectious Disease, LLC | Internal Medicine | 1110 London St Ste 102, Myrtle Beach, SC 29577 | 2016-01-07 |
| 1548639933 | Susan Lang | Social Worker | 1273 Professional Dr., Suite A #104, Myrtle Beach, SC 29577 | 2015-09-16 |
| 1043600893 | Kenneth Edward Smith | Counselor | 1125 48th Avenue North, Myrtle Beach, SC 29577 | 2015-02-02 |
| 1902203615 | Sc Nursing Services LLC | Home Infusion | 1297 Professional Drive, Suite 201 C3, Myrtle Beach, SC 29577 | 2014-11-24 |
| 1881007946 | Intercoastal Endo, PC | Dentist | 4382 Oleander Dr, Myrtle Beach, SC 29577 | 2014-06-06 |
| 1891115739 | Julie Hite | Pharmacist | 540 Seaboard Street, Myrtle Beach, SC 29577 | 2014-04-18 |
| Find all providers in zip 29577 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609437961 | Tidelands Health Market Common LLC | Physiological Laboratory | 2200 Crow Ln Ste 103, Myrtle Beach, SC 29577-1663 | 2019-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780113324 | Carolinas Imaging Services LLC | Physiological Laboratory | 1656 Riverchase Blvd Ste 1600, Rock Hill, SC 29732-1984 | 2017-06-07 |
| 1184099046 | Braincare, LLC | Physiological Laboratory | 1320 Main St Ste 347, Columbia, SC 29201-3204 | 2015-12-03 |
| 1114318813 | Palmetto Diagnostics, LLC | Physiological Laboratory | 1060 Chris Cir, Suite D, West Columbia, SC 29169-4773 | 2015-02-17 |
| 1568734614 | The Hark Group, LLC | Physiological Laboratory | 52 Golden Spur Ln, Blythewood, SC 29016-7600 | 2012-02-06 |
| 1255654877 | Atlantic Sleep Disorders Center LLC | Physiological Laboratory | 9657 S Ocean Hwy 17, Ste 4b, Pawleys Island, SC 29585-7425 | 2010-03-10 |
| 1619117678 | Charleston Neuroscience Institute LLC | Physiological Laboratory | 9551 Hwy 78, Bldg 700 Suite 103, Ladson, SC 29406 | 2009-03-03 |
| 1225278641 | Charleston Neuroscience Institute | Physiological Laboratory | 590 Lone Tree Drive Ste 101, Mount Pleasant, SC 29464 | 2009-02-25 |
| 1558304824 | Carolina Diagnostics, LLC | Physiological Laboratory | 1701 Devonshire Dr, Suite 102, Columbia, SC 29204-2404 | 2006-06-14 |
| 1528017415 | Diagnostic Health Corporation | Physiological Laboratory | 1 Cannon Dr, Greenville, SC 29605-4201 | 2006-05-08 |
| 1174572069 | Diagnostic Health Center of Hilton Head LLC | Physiological Laboratory | 13 Lamotte Dr, Hilton Head Island, SC 29926-2743 | 2006-05-08 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29577 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.