Coastal Carolina Medical Center, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

COASTAL CAROLINA MEDICAL CENTER, INC.

Doing business as

Coastal Carolina Medical Associates

Practice address

1010 Medical Center Dr
Suite 240
Hardeeville, SC 29927-3447

Phone

(843) 784-8293

Fax

(843) 784-7801

NPI assigned

Feb 2, 2011

Last updated

Mar 22, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

COASTAL CAROLINA HOSPITALAs reported in NPPES

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

Authorized official

Name

Mr. Ron O. Groteluschen

Title

Cfo

Phone

(843) 784-8076

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Coastal Carolina Medical Associates Doing business as

Part of

Coastal Carolina Med Ctr

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1144526500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741261",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741261",
            "telephone_number": "843-784-8293",
            "fax_number": "843-784-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 MEDICAL CENTER DR",
            "address_2": "SUITE 240",
            "city": "HARDEEVILLE",
            "state": "SC",
            "postal_code": "299273447",
            "telephone_number": "843-784-8293",
            "fax_number": "843-784-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL CAROLINA HOSPITAL",
        "enumeration_date": "2011-02-02",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "GROTELUSCHEN",
        "authorized_official_first_name": "RON",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "843-784-8076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC 551",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Carolina Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Carolina Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rural Health Clinic/Center in Hardeeville, SC
• Providers in Hardeeville, SC by specialty
• Rural Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.