Grand Strand Mobile Wound Care

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

GRAND STRAND MOBILE WOUND CARE

Practice address

1297 Professional Dr Ste 201
Myrtle Beach, SC 29577-5713

Phone

(803) 999-6863

Fax

(855) 834-3003

NPI assigned

Feb 6, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Hathway, PA-CNPI 1982615795

Title

Owner

Phone

(617) 959-4427

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Eric Hathway, PA

  • Physician Assistant
  • Conway, SC
  • NPI 1982615795
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1738800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1508670837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 STARLIT WAY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295794322",
            "telephone_number": "803-999-6863",
            "fax_number": "855-834-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1297 PROFESSIONAL DR STE 201",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775713",
            "telephone_number": "803-999-6863",
            "fax_number": "855-834-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND STRAND MOBILE WOUND CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-06",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "HATHWAY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-959-4427",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand Strand Family and Esthetic Dentistry
• Grand Strand Family and Esthetic Dentistry
• Grand Strand Gynecology
• Grand Strand Healthcare, Inc.
• Grand Strand Internal Medicine PC
• Grand Strand Pediatric Dentistry
• Grand Strand Pediatrics & Adolescent Medicine, P.a.
• Grand Strand Plastic & Reconstructive Surgery Center PA
• Grand Strand Psychological Services, PA
• Grand Strand Regional Medical Center, LLC

• Medical Specialty Clinic/Center in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Medical Specialty Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.