CAROLINA REGIONAL CANCER CENTER LLC (NPI# 1679524714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679524714 |
| Entity Type | Organization |
| Organization Name | CAROLINA REGIONAL CANCER CENTER LLC |
| Other Organization Name | CAROLINA REGIONAL CANCER CENTER INC |
| Practice Address |
4708 Oleander Drive Myrtle Beach SC 29577 |
| Mailing Address |
2234 Colonial Blvd Fort Myers FL 33907-1412 |
| Practice Telephone | 8434499415 |
| Practice Fax Number | 8434492160 |
| Mailing Telephone | 2399317342 |
| Mailing Fax Number | 2399317385 |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2019-07-12 |
| Authorized Official Name | KIM COMMINS (CEO) |
| Authorized Official Telephone | 2399317277 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GHI | 9620580 | 01 | |
| PA | BCBS | 503356 | 01 |
| RAILROAD MEDICARE | CG7705 | 01 | |
| SC | GP0968 | 05 | |
| NC | BCBS | 02260 | 01 |
| NC | 8902260 | 05 |
| Other Name | Type Code |
|---|---|
| Carolina Regional Cancer Center Inc | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CAROLINA REGIONAL CANCER CENTER LLC | 252 Myrtle Trace Drive Ext, Conway, SC 29526-8986 |
| Street Address |
4708 OLEANDER DRIVE |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29577 |
| 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 | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033118005 | Robert Steven Bass | Radiology | 4708 Oleander Dr, Myrtle Beach, SC 29577-5742 | 2005-07-20 |
| 1962401042 | Paul G Goetowski | Radiology | 5335 N Kings Hwy # 144, Myrtle Beach, SC 29577-2520 | 2005-07-20 |
| 1245593235 | David W. Zaenger | Radiology | 4708 Oleander Dr, Myrtle Beach, SC 29577 | 2012-06-24 |
| 1457589608 | Geoffrey Lance Ray | Radiology | 809 82nd Pkwy, Myrtle Beach, SC 29572-4607 | 2009-06-26 |
| 1568444529 | Stephen Francis Andrews | Radiology | 4708 Oleander Dr, Myrtle Beach, SC 29577-5742 | 2005-11-16 |
| 1346240306 | Todd E Williams | Radiology | 4708 Oleander Dr, Myrtle Beach, SC 29577-5742 | 2005-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659885754 | Providence Physician Practices, LLC | Radiology | 114 Gateway Corporate Blvd Ste 440, Columbia, SC 29203-9785 | 2017-11-28 |
| 1497045058 | Charles Eric Wooten | Radiology | 805 Pamplico Hwy Ste A315, Florence, SC 29505-6056 | 2011-04-15 |
| 1174769764 | Beaufort County Memorial Hospital | Radiology | 989 Ribaut Rd Ste 130, Beaufort, SC 29902 | 2009-01-02 |
| 1255518734 | Paul Anthony Saconn | Radiology | 122 Okatie Center Blvd N, Okatie, SC 29909-3750 | 2008-01-27 |
| 1508042201 | Newberry Oncology Associates | Radiology | 298 Commerce Dr., Newberry, SC 29108 | 2008-01-14 |
| 1972624484 | James Fyffe Mcnab | Radiology | 1680 Ribaut Raod, Ste A, Port Royal, SC 29935-2029 | 2007-04-02 |
| 1568516383 | Edward William Duffy Jr. | Radiology | 130 North Washington Street, Sumter, SC 29150 | 2007-01-22 |
| 1811908064 | Vipul V Thakkar | Radiology | 228 S Herlong Ave, Rock Hill, SC 29732-1158 | 2006-08-11 |
| 1285645937 | Eduard Dvorak | Radiology | 30494 435th Ave, Utica, SC 57067-5905 | 2006-08-10 |
| 1013947589 | Larry Douglas Grubb | Radiology | 130 N Washington St, Sumter, SC 29150-4920 | 2006-07-03 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29577 |
Please comment or provide details below to improve the information on CAROLINA REGIONAL CANCER CENTER 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.