Little River Medical Center, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LITTLE RIVER MEDICAL CENTER, INC.

Practice address

1411 10TH Ave N
Myrtle Beach, SC 29577-5615

Phone

(843) 663-8000

Fax

(843) 663-1017

NPI assigned

Mar 30, 2012

Last updated

Mar 30, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

LITTLE RIVER MEDICAL CENTER, INC.As reported in NPPES

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

Authorized official

Name

Avangela K Criswell

Title

Business Office Director

Phone

(843) 663-8017

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225304546. Details of each certification follow.

• CCN 421958 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 421958

Legal name

LITTLE RIVER MEDICAL CENTER INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 18, 2012

Last certification

Jun 18, 2012

Ownership / control type

For profit – corporation

Facility address

1411 10TH Avenue North
Myrtle Beach, SC 29577

Part of

Little River Medical Center Pharmacy

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1225304546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295660547",
            "telephone_number": "843-663-8000",
            "fax_number": "843-663-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 10TH AVE N",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775615",
            "telephone_number": "843-663-8000",
            "fax_number": "843-663-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "CRISWELL",
        "authorized_official_first_name": "AVANGELA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "843-663-8017"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "3657",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "SC",
            "license": "7136",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Little River Medical Center Pharmacy
• Little River Medical Center, Inc
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.
• Little River Medical Center, Inc.

• Family Medicine Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.