Coastal Med Spa, LLC

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

Legal business name

COASTAL MED SPA, LLC

Practice address

4006 Postal Way Unit a
Myrtle Beach, SC 29579-3527

Phone

(843) 796-1769

NPI assigned

Sep 17, 2025

Organization subpart

No

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

Authorized official

Name

Laura Rice

Title

Authorized Official

Phone

(843) 796-1769

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bi A. Tadzong-Fomundam, M.D.

  • Dermatology Physician
  • Myrtle Beach, SC
  • NPI 1710148648

  Public Health & General Preventive Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1758067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1134090582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 POSTAL WAY UNIT A",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793527",
            "telephone_number": "843-796-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4006 POSTAL WAY UNIT A",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793527",
            "telephone_number": "843-796-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MED SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-17",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "843-796-1769"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Grande OB-GYN,LLC
• Coastal Guardians LLC
• Coastal Haven Counseling LLC
• Coastal Home Care
• Coastal Human Resources LLC
• Coastal Optical, Incorporated
• Coastal Periodontics LLC
• Coastal Podiatry Associates PA
• Coastal Podiatry Associates PA
• Coastal Podiatry Associates, PA

• Public Health & General Preventive Medicine Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Public Health & General Preventive Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.