NPIMap

Organization Active NPI

Coastal Family Medicine

  • Legal Medicine
  • Conway, SC
National Provider Identifier
1548459597
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
MD 7055 Issued in SC
Legal business name
COASTAL FAMILY MEDICINE
Practice address
8014 Myrtle Trace Dr
Conway, SC 29526-8945
Phone
(843) 347-7224
Fax
(843) 347-7335
NPI assigned
Oct 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Jonathan L Dieter Jr., MDNPI 1205987419
Title
Owner
Phone
(843) 347-7224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X SINGLE SPECIALTY GROUP 173000000X MD 7055 SC Primary

Addresses

Primary practice location

8014 Myrtle Trace Dr
Conway, SC 29526-8945

Mailing address

8014 Myrtle Trace Dr
Conway, SC 29526-8945
Phone (843) 347-7224

Other identifiers 2

IdentifierTypeStateIssuer
2958OtherSCMEDICARE PROVIDER NUMBER
PC4269OtherSCMEDICAID PROVIDER NUMBER

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": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1548459597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8014 MYRTLE TRACE DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-347-7224",
            "fax_number": "843-347-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8014 MYRTLE TRACE DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-347-7224",
            "fax_number": "843-347-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "DIETER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-347-7224",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "SC",
            "license": "MD 7055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "2958",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER NUMBER",
            "identifier": "PC4269",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.