NPIMap

Organization Active NPI

Tamara Willard

  • Community/Behavioral Health Agency
  • Myrtle Beach, SC
National Provider Identifier
1215462742
Registry record updated Apr 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
4859 Issued in SC
Legal business name
TAMARA WILLARD
Practice address
4221 Mayfair St
Myrtle Beach, SC 29577-5757
Phone
(843) 360-9491
NPI assigned
Apr 21, 2017
Last updated
Apr 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2017

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

Authorized official

Name
Tamara WillardNPI 1518138742
Title
Owner
Phone
(843) 360-9491

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 4859 SC Primary

Addresses

Primary practice location

4221 Mayfair St
Myrtle Beach, SC 29577-5757

Mailing address

4221 Mayfair St
Myrtle Beach, SC 29577-5757

Other identifiers 1

IdentifierTypeStateIssuer
PC1117MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1215462742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 MAYFAIR ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 MAYFAIR ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775757",
            "telephone_number": "843-360-9491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAMARA WILLARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "WILLARD",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-360-9491"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": "4859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC1117",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; 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.