CHARLESTON VAMC (NPI# 1164810297) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164810297 |
| Entity Type | Organization |
| Organization Name | CHARLESTON VAMC |
| Other Organization Name | MYRTLE BEACH 1 VA CLINIC |
| Practice Address |
1101 Johnson Ave Suite R-2a Myrtle Beach SC 29577-1893 |
| Mailing Address |
Po Box 89425 Cleveland OH 44101-6425 |
| Practice Telephone | 8282572333 |
| Mailing Telephone | 8282572333 |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2018-04-13 |
| Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| MYRTLE BEACH 1 VA CLINIC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083099444 | Charleston Vamc | Clinic/Center | 2424 City Hall Lane, North Charleston, SC 29406-9998 | 2015-07-28 |
| 1851339451 | Charleston Vamc | Clinic/Center | 1170 Shawnee Street, Savannah, GA 31419-1618 | 2006-06-03 |
| 1255729398 | Charleston Vamc | Clinic/Center | 9229 University Blvd, North Charleston, SC 29406-9150 | 2014-12-23 |
| 1437566528 | Charleston Vamc | Clinic/Center | 9237 University Blvd, North Charleston, SC 29406-9189 | 2014-07-21 |
| 1427344308 | Charleston Vamc | Clinic/Center | 500 E Oglethorpe Hwy, Hinesville, GA 31313-2804 | 2011-06-20 |
| 1235286741 | Charleston Vamc | Clinic/Center | 2418 Nnptc Circle, Goose Creek, SC 29445-9998 | 2007-01-05 |
| 1649286972 | Charleston Vamc | General Acute Care Hospital | 109 Bee Street, Charleston, SC 29401 | 2006-07-31 |
| 1821036286 | Charleston Vamc | Clinic/Center | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1533 | 2006-06-04 |
| 1194776807 | Charleston Vamc | Clinic/Center | 1 Pinckney Blvd, Beaufort, SC 29902-6122 | 2006-05-15 |
| 1659320620 | Charleston Vamc | General Acute Care Hospital | 109 Bee St, Charleston, SC 29401-5703 | 2006-05-08 |
| Street Address |
1101 JOHNSON AVE SUITE R-2A |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29577-1893 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619969250 | Randall Paul Grove | Physician Assistant | 1101 Johnson Ave, Myrtle Beach, SC 29577-1893 | 2005-08-19 |
| 1629617485 | Tarzaris Mack | Social Worker | 1101 Johnson Ave, Myrtle Beach, SC 29577-1893 | 2019-12-27 |
| 1720633621 | Ethel Mae Santai | Physical Therapist | 1101 Johnson Ave, Myrtle Beach, SC 29577-1893 | 2019-08-07 |
| 1912560095 | Stephen Francis Kovacs IIi | Social Worker | 1101 Johnson Ave, Myrtle Beach, SC 29577-1893 | 2019-04-15 |
| 1831676857 | Stacey M Fontaine | Social Worker | 1101 Johnson Ave, Myrtle Beach, SC 29577-1893 | 2018-07-23 |
| 1770077588 | Richard Mehlbrech | Physical Therapist | 1101 Johnson Ave, Myrtle Beach, SC 29577 | 2018-06-15 |
| 1013367960 | Willa Fry | Audiologist | 1101 Johnson Ave, Suite 204, Myrtle Beach, SC 29577-1893 | 2016-06-21 |
| 1114382264 | Paul Anama | Physical Therapist | 1101 Johnson Ave, Rm 138, Myrtle Beach, SC 29577-1893 | 2015-12-16 |
| 1518346097 | Jamie Wright | Social Worker | 1101 Johnson Ave, Suite 204, Myrtle Beach, SC 29577-1893 | 2015-05-29 |
| 1447653415 | Kimberly Patricia Cuddy | Psychologist | 1101 Johnson Ave, Myrtle Beach, SC 29577 | 2014-10-03 |
| Find all providers in the same location | ||||
| 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 | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821036286 | Charleston Vamc | Clinic/Center | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1533 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083099444 | Charleston Vamc | Clinic/Center | 2424 City Hall Lane, North Charleston, SC 29406-9998 | 2015-07-28 |
| 1306014113 | Augusta Vamc | Clinic/Center | 950 Millbrook Ave, Aiken, SC 29803-0602 | 2008-02-14 |
| 1972542983 | Columbia Vamc | Clinic/Center | 407 N Salem Ave, Sumter, SC 29150-4115 | 2006-06-05 |
| 1588617815 | Columbia Vamc | Clinic/Center | 1822 Sally Hill Farms Blvd, Florence, SC 29501-6987 | 2006-05-18 |
| 1215988480 | Columbia Vamc | Clinic/Center | 1702 E Greenville St, Anderson, SC 29621-2009 | 2006-05-13 |
| 1053786228 | Columbia Vamc | Clinic/Center | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2015-12-14 |
| 1255729398 | Charleston Vamc | Clinic/Center | 9229 University Blvd, North Charleston, SC 29406-9150 | 2014-12-23 |
| 1437566528 | Charleston Vamc | Clinic/Center | 9237 University Blvd, North Charleston, SC 29406-9189 | 2014-07-21 |
| 1861643181 | Columbia Vamc | Clinic/Center | 279 N Grove Medical Park Dr, Spartanburg, SC 29303-4222 | 2008-10-06 |
| 1235286741 | Charleston Vamc | Clinic/Center | 2418 Nnptc Circle, Goose Creek, SC 29445-9998 | 2007-01-05 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29577 |
Please comment or provide details below to improve the information on CHARLESTON VAMC.
| 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.