NPIMap

Organization Active NPI

Grand Strand Senior Health Center, LLC

  • Internal Medicine Physician
  • Myrtle Beach, SC
National Provider Identifier
1649269085
Registry record updated Jan 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRAND STRAND SENIOR HEALTH CENTER, LLC
Practice address
5046 Highway 17 Byp S
Suite 100
Myrtle Beach, SC 29588-4503
Phone
(843) 839-6192
Fax
(843) 839-6164
NPI assigned
Oct 18, 2005
Last updated
Jan 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2008

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

Authorized official

Name
Mr. Patrick Birmingham
Title
Director
Phone
(615) 373-7625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

5046 Highway 17 Byp S
Suite 100
Myrtle Beach, SC 29588-4503

Mailing address

5046 Highway 17 Byp S
Suite 100
Myrtle Beach, SC 29588-4503
Phone (843) 839-6192

Other identifiers 1

IdentifierTypeStateIssuer
GP3814MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201046400000",
    "number": "1649269085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5046 HIGHWAY 17 BYP S",
            "address_2": "SUITE 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295884503",
            "telephone_number": "843-839-6192",
            "fax_number": "843-839-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5046 HIGHWAY 17 BYP S",
            "address_2": "SUITE 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295884503",
            "telephone_number": "843-839-6192",
            "fax_number": "843-839-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND STRAND SENIOR HEALTH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2008-01-23",
        "status": "A",
        "authorized_official_last_name": "BIRMINGHAM",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-373-7625",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3814",
            "state": "SC"
        }
    ],
    "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 Jan 23, 2008; 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.