Coastal Carolina ENT, DO, PA
Organization Active NPI Facial Plastic Surgery Physician · Little River, SC
NPI 1386989028 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1386989028
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Facial Plastic Surgery Physician 207YS0123X
- License
- DO 1480 (SC)
- Legal business name
- COASTAL CAROLINA ENT, DO, PA
- Practice address
- 3806 Sawtell Rd
Little River, SC 29566-7873 - Phone
- (843) 663-9090
- Fax
- (843) 663-9091
- NPI assigned
- Dec 6, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- COASTAL CAROLINA ENT, DO, PA
Authorized official
- Name
- Ms. Wendy C. Paris, CPC
- Title
- Insurance/Billing Specialist
- Phone
- (910) 914-0540
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 7
-
Michael D Peters, M.D.
-
Erik L Kenyon, DO
-
Savannah Parker Ward, FNP
-
Jayna Patel, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130219000386 | SC | Part B Supplier - Clinic/Group Practice | 8325082498 |
Receives reassigned benefits from 3 practitioners Practice locations: Little River, SC; Whiteville, NC; Supply, NC |
National Provider Directory
- Tax ID family
- Coastal Carolina ENT DO
- Part of
- Coastal Carolina ENT DO
Locations
509 Olde Waterford Way
Ste 204
Leland, NC 28451
Phone (910) 356-6100
333 Jefferson St
Whiteville, NC 28472
Phone (910) 642-6915
110 Highway 17 S
Ste 112
North Myrtle Beach, SC 29582
110 Highway 17 S
North Myrtle Beach, SC 29582
Phone (843) 663-9090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Facial Plastic Surgery Physician |
207YS0123X | DO 1480 | SC | Yes |
Addresses
Primary practice location
3806 Sawtell Rd
Little River, SC 29566-7873
Mailing address
302 Liberty St
Whiteville, NC 28472-3714
Phone (910) 914-0540
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689757007 | Other | NC | NC NPI |
| 1386989028 | Other | SC | NPI |
Other providers in Little River, SC
- Felicia Clemens
- Clemson Sports Medicine and Rehabilitation
- Clemson Sports Medicine and Rehabilitation
- Clemson Sports Medicine and Rehabilitation, Inc
- Coastal Carolina ENT
- Coastal Chiropractic Care LLC
- Coastal Cosmetic Dental Associates,
- Coastal Eye Group, PC
- Coastal Hearing Centers, Inc
- Coastal Pain Care
All providers in Little River, SC · Facial Plastic Surgery Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.