COASTAL CAROLINA PRIMARY CARE, LLC (NPI# 1164783643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164783643 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA PRIMARY CARE, LLC |
| Practice Address |
106 W Main St Moncks Corner SC 29461-2601 |
| Practice Telephone | 8437611995 |
| Mailing Telephone | 8437611995 |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |
| Authorized Official Name | WAYNE O WHINNEY (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 8438567924 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821257676 | Coastal Carolina Primary Care, LLC | Internal Medicine | 9221 University Blvd Ste 102, North Charleston, SC 29406-9148 | 2008-06-06 |
| 1942522719 | Coastal Carolina Primary Care, LLC | Family Medicine | 3601 Ladson Rd, Suite 101, Ladson, SC 29456-4304 | 2010-02-22 |
| Street Address |
106 W MAIN ST |
| City | MONCKS CORNER |
| State | SC |
| Zip Code | 29461-2601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659872059 | Fetter Health Care Network, Inc. | Clinic/Center | 106 W Main St, Moncks Corner, SC 29461-2601 | 2018-02-22 |
| 1588095988 | Samantha Wadford | Nurse Practitioner | 106 W Main St, Moncks Corner, SC 29461-2601 | 2013-12-10 |
| 1942474770 | Michelle Davis Smith | Nurse Practitioner | 106 W Main St, Moncks Corner, SC 29461-2601 | 2008-04-14 |
| 1417137803 | Berkeley Medical Center, LLC | Internal Medicine | 106 W Main St, Moncks Corner, SC 29461-2601 | 2007-11-14 |
| 1548299159 | Rose Delores Gibbs | Internal Medicine | 106 W Main St, Moncks Corner, SC 29461 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982267605 | Berkeley Citizens Inc | Early Intervention Provider Agency | P0 Drawer 429 1301 Old Hwy 52 South, Moncks Corner, SC 29461 | 2019-04-18 |
| 1376015222 | Anthony Johnson | Counselor | 306 Airport Drive, Moncks Corner, SC 29461 | 2018-12-17 |
| 1598243719 | Jana Matthews Chinners | Family Medicine | 2061 Us-52, Moncks Corner, SC 29461 | 2018-07-31 |
| 1285151225 | Nathan Andrew Bostrom | Occupational Therapist | 118 Carolina Avenue, Moncks Corner, SC 29461 | 2017-08-29 |
| 1942730528 | Martina Snider | Specialist | 393 Corner Square Plaza, Moncks Corner, SC 29461 | 2017-06-15 |
| 1104355502 | Mary Elizabeth Perdue | Counselor | 306 Airport Dr., Moncks Corner, SC 29461 | 2017-06-08 |
| 1619390481 | Berkeley Citizens, Inc. | Public Health or Welfare | 1301 Old Hwy. 52 South, Moncks Corner, SC 29461 | 2014-01-29 |
| 1326384082 | Amanda Trueworthy | Counselor | 3156 F South Live Oak Drive, Moncks Corner, SC 29461 | 2012-12-27 |
| 1790040202 | Melanie Mcendree | Community Health Worker | 105 Lobolly Dr., Moncks Corner, SC 29461 | 2012-07-10 |
| 1891093845 | Leslie Erin Blackmon Stelling | Pharmacist | 110 South Highway 52, Moncks Corner, SC 29461 | 2011-02-28 |
| Find all providers in zip 29461 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245550821 | Moncks Corner Pediatrics LLC | Clinic/Center | 5000 Epson Plantation Dr Ste B, Moncks Corner, SC 29461-3979 | 2010-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508482050 | The Palmetto Clinics, LLC | Clinic/Center | 463 Calhoun Ave Ste A-2, Greenwood, SC 29649-2063 | 2020-06-21 |
| 1962969154 | The Palmetto Palace | Clinic/Center | 217 Flat St E, Allendale, SC 29810-4647 | 2019-02-25 |
| 1972014652 | Mcleod Physician Associates II | Clinic/Center | 1040 Marlboro Way Ste 1, Bennettsville, SC 29512-2494 | 2017-10-20 |
| 1508377284 | Mcleod Physician Associates II | Clinic/Center | 1076 Marlboro Way Ste 3, Bennettsville, SC 29512-2495 | 2017-10-20 |
| 1154786960 | R Dale Padgett Md Pa | Clinic/Center | 1727 Villagepark Dr, Orangeburg, SC 29118 | 2015-12-21 |
| 1043602428 | Greenville Health System | Clinic/Center | 208 Frontage Rd Ste 1, Clemson, SC 29631-1671 | 2015-02-23 |
| 1114204153 | Mcleod Physician Associates II | Clinic/Center | 5260 Highway 9, Green Sea, SC 29545-4930 | 2011-11-04 |
| 1700160157 | Mackey Family Practice, Pa | Clinic/Center | 8351 Charlotte Hwy, Suite 200, Indian Land, SC 29707-6552 | 2011-10-04 |
| 1588943021 | Edisto Regional Health Services Inc. | Clinic/Center | 185 Mcgee St, Bamberg, SC 29003-1154 | 2011-08-16 |
| 1124307509 | Coastal Carolina Medical Center, Inc | Clinic/Center | 10911 N Jacob Smart Blvd, D, Ridgeland, SC 29936-2729 | 2011-08-16 |
| Find all providers with the same taxonomy | ||||
| City | MONCKS CORNER |
| Zip Code | 29461 |
Please comment or provide details below to improve the information on COASTAL CAROLINA PRIMARY CARE, LLC.
| 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.