Tidewater Health PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TIDEWATER HEALTH PC

Doing business as

Tidewater Health

Practice address

1435 Stuart Engals Blvd Ste 101
Mount Pleasant, SC 29464-7312

Phone

(843) 800-5686

Fax

(843) 800-5656

NPI assigned

Mar 15, 2018

Organization subpart

No

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

Authorized official

Name

Dr. David L Smith, MDNPI 1710999750

Title

President

Phone

(843) 800-5686

Specialties & licenses 1

Addresses

Other names 1

• Tidewater Health Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• David L Smith, MD

  • Family Medicine Physician
  • Mount Pleasant, SC
  • NPI 1710999750
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556668800000",
    "number": "1649773789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 STUART ENGALS BLVD STE 101",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294647312",
            "telephone_number": "843-800-5686",
            "fax_number": "843-800-5656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 STUART ENGALS BLVD STE 101",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294647312",
            "telephone_number": "843-800-5686",
            "fax_number": "843-800-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2019-05-01",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-800-5686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tidewater Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lara Jennifer Tiberian
• Sara Sharnoff Tick, LMFT
• Tidal Creek Dental LLC
• Tides Gastroenterology, LLC
• Tides of Change Counseling, LLC
• Tidewater Neurology
• Tidewater Pharmacy & Medical Supply LLC (Tidewater Pharmacy & Compounding)
• Tidewater Pharmacy & Medical Supply LLC (Tidewater Pharmacy & Compounding)
• Tidewater Pharmacy & Medical Supply LLC (Tidewater Pharmacy & Compounding)
• Tidewater Pharmacy & Medical Supply LLC

• Primary Care Clinic/Center in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.