Coastal Grand OBGYN PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

222100 Issued in SC

Legal business name

COASTAL GRAND OBGYN PC

Practice address

1021 Medical Cir
Suite 250
Myrtle Beach, SC 29572-4619

Phone

(843) 421-8200

Fax

(843) 839-3634

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Spielvogel, M.D.

Title

Owner/M.D.

Phone

(843) 421-8200

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1083777486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 MEDICAL CIR",
            "address_2": "SUITE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724619",
            "telephone_number": "843-421-8200",
            "fax_number": "843-839-3634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 MEDICAL CIR",
            "address_2": "SUITE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724619",
            "telephone_number": "843-421-8200",
            "fax_number": "843-839-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL GRAND OBGYN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "SPIELVOGEL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER/M.D.",
        "authorized_official_telephone_number": "843-421-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "222100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4188",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coastal DME LLC
• Coastal Eye Associates
• Coastal Eye Group, P.C.
• Coastal Eye Group, P.C.
• Coastal Grand Eye Associates LTD. Co.
• Coastal Grande OB-GYN,LLC
• Coastal Guardians LLC
• Coastal Haven Counseling LLC
• Coastal Home Care
• Coastal Human Resources LLC

• Specialist in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.