NPIMap

Organization Active NPI

Coastal Cancer Center LLC

Doing business as Coastal Cancer Center

  • Hematology & Oncology Physician
  • Conway, SC
National Provider Identifier
1063432391
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
11181 Issued in SC
Legal business name
COASTAL CANCER CENTER LLC
Doing business as
Coastal Cancer Center
Practice address
817 Farrar Dr
Conway, SC 29526-8747
Phone
(843) 234-1660
Fax
(843) 692-5015
NPI assigned
Jul 20, 2006
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Vijay Paudel, MDNPI 1972596484
Title
Partner
Phone
(843) 692-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Hematology & Oncology Physician 207RH0003X 11181 SC Primary

Addresses

Primary practice location

817 Farrar Dr
Conway, SC 29526-8747

Mailing address

8121 Rourk St
Myrtle Beach, SC 29572-4128
Phone (843) 692-5000

Other identifiers 2

IdentifierTypeStateIssuer
790248NMedicaidNC
GP2750MedicaidSC

Other names 1

  • COASTAL CANCER CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000696 SC Part B Supplier - Clinic/Group Practice 1456265503 Receives reassigned benefits from 23 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Loris, SC; Myrtle Beach, SC; Conway, SC; Murrells Inlet, SC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1063432391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8121 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724128",
            "telephone_number": "843-692-5000",
            "fax_number": "843-692-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 FARRAR DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268747",
            "telephone_number": "843-234-1660",
            "fax_number": "843-692-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CANCER CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2025-09-02",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "PAUDEL",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-692-5000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "11181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790248N",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2750",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COASTAL CANCER CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.