NPIMap

Organization Active NPI

Little River Medical Center, Inc.

  • Family Medicine Physician
  • Myrtle Beach, SC
National Provider Identifier
1225304546
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
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
Organization subpart
Yes
Parent organization
LITTLE RIVER MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 3657 SC
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X 7136 SC
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X SC Primary

Addresses

Primary practice location

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

Mailing address

PO Box 547
Little River, SC 29566-0547
Phone (843) 663-8000

National Provider Directory

National Provider Directory
Part of
Little River Medical Center Inc

NPI Registry JSON

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": []
}

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 Mar 30, 2012; 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.