COASTAL CAROLINA ENT, DO, PA (NPI# 1386989028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386989028 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA ENT, DO, PA |
| Practice Address |
110 Highway 17 S Suite 112 - Sundial Center North Myrtle Beach SC 29582-3118 |
| Mailing Address |
302 Liberty St Whiteville NC 28472-3714 |
| Practice Telephone | 8436639090 |
| Practice Fax Number | 8436639091 |
| Mailing Telephone | 9109140540 |
| Mailing Fax Number | 9109140640 |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2013-06-03 |
| Authorized Official Name | MS. WENDY C. PARIS (INSURANCE/BILLING SPECIALIST) |
| Authorized Official Telephone | 9109140540 |
| Authorized Official Credential | CPC |
| Is Organization Subpart | Y |
| Parent Organization Name | COASTAL CAROLINA ENT, DO, PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
DO 1480 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NC NPI | 1689757007 | 01 |
| SC | NPI | 1386989028 | 01 |
| Street Address |
110 HIGHWAY 17 S SUITE 112 - SUNDIAL CENTER |
| City | NORTH MYRTLE BEACH |
| State | SC |
| Zip Code | 29582-3118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942812656 | J&r Angels Care Services LLC | In Home Supportive Care | North Myrtle Beach Business Center Ste 115 1019 Hwy 17s, North Myrtle Beach, SC 29582 | 2020-08-24 |
| 1215561865 | Janella Jackson | In Home Supportive Care | North Myrtle Beach Business Center Suite 115, 1019 Hwy 17s, North Myrtle Beach, SC 29582 | 2020-02-22 |
| 1780147504 | Cherry Grove Compounding, LLC | Pharmacy | 1124-2 Sea Mountain Highway, North Myrtle Beach, SC 29582 | 2019-04-09 |
| 1598125437 | Jebediah S Christy-north Myrtle Beach Pllc | Dentist | 1376 Hwy 17 N, North Myrtle Beach, SC 29582 | 2016-03-04 |
| 1972907277 | John Soileau | Veterinarian | 1530 Old Highway 17 N, North Myrtle Beach, SC 29582 | 2014-10-15 |
| 1306248422 | Dental Professionals of Sc, PC | Dentist | 1586 Hwy 17n, North Myrtle Beach, SC 29582 | 2014-09-19 |
| 1477899680 | Jessica Ober | Physical Therapist | 1100 David St., Apt #1208, North Myrtle Beach, SC 29582 | 2012-12-14 |
| 1568711646 | Erin Dixon | Pharmacist | 781 Main Street, North Myrtle Beach, SC 29582 | 2012-09-05 |
| 1972875722 | Medical Comfort Systems | Durable Medical Equipment & Medical Supplies | 1108 Sea Mountain Hwy Ste 3, North Myrtle Beach, SC 29582 | 2012-02-08 |
| 1295023869 | Jenna Lynne Dukes | Pharmacist | 1201 Sea Mountain Hwy, North Myrtle Beach, SC 29582 | 2011-07-18 |
| Find all providers in zip 29582 | ||||
| Taxonomy Code | 207YS0123X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Facial Plastic Surgery |
| An otolaryngologist who specializes in facial plastic surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316917057 | Peter C Bondy | Otolaryngology | 808 Farrar Dr, Conway, SC 29526-8747 | 2006-01-25 |
| 1194144493 | Charleston Facial Plastic Surgery LLC | Otolaryngology | 67 Broad St, Suite 200, Charleston, SC 29401-2936 | 2014-04-15 |
| 1043471394 | Stephen J. Kroll, M.d. Pa | Otolaryngology | 338 Harbison Blvd, Columbia, SC 29212-2248 | 2008-06-19 |
| 1063687325 | David Watson Rodwell IIi | Otolaryngology | 67 Broad St, Suite 200, Charleston, SC 29401-2936 | 2008-04-28 |
| 1487857272 | Patrick Constantine Angelos | Otolaryngology | 2295 Henry Tecklenburg Dr, Charleston, SC 29414-7801 | 2007-06-07 |
| 1629299375 | Drew V Collins | Otolaryngology | 105 Carter Park Dr, Suite B, Seneca, SC 29678-1152 | 2007-05-01 |
| 1518181148 | Daniel Frederick Boxwell | Otolaryngology | 105 Carter Park Dr, Suite B, Seneca, SC 29678-1152 | 2007-04-13 |
| 1679594261 | Carolina Facial Plastic Surgery Pa | Otolaryngology | 1714 Gregg Ave, Florence, SC 29501-4120 | 2006-07-21 |
| 1386698165 | Seacoast Ent & Facial Plastic Surgery, Pa | Otolaryngology | 4000 Highway 9 E, Suite 270, Little River, SC 29566-7833 | 2006-05-19 |
| City | NORTH MYRTLE BEACH |
| Zip Code | 29582 |
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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.