Tidelands GHS Joint Venture LLC

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

Legal business name

TIDELANDS GHS JOINT VENTURE LLC

Practice address

2591 N Fraser St
Georgetown, SC 29440-6411

Phone

(843) 546-3410

Fax

(843) 527-6964

NPI assigned

Nov 5, 2014

Organization subpart

Yes

Parent organization

TIDELANDS GHS JOINT VENTURE LLCAs reported in NPPES

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

Authorized official

Name

Julia Doar Stalvey

Title

Cfo

Phone

(843) 546-3410

Specialties & licenses 1

Addresses

Other names 1

• Tidelands Community Palliative Care Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Tidelands GHS Joint Venture LLC

  • Community Based Hospice Care Agency
  • Georgetown, SC
  • NPI 1154303089

  6800030578

  Same PAC ID

Tax ID family

Tidelands GHS Joint Venture2 organizations share this tax ID, including this one

Part of

Tidelands GHS Joint Venture

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tidelands GHS Joint Venture LLC

  • Community Based Hospice Care Agency
  • Georgetown, SC
  • NPI 1154303089
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Tidelands GHS Joint Venture LLC

  • Community Based Hospice Care Agency
  • Georgetown, SC
  • NPI 1154303089
  NPPES parent name

Practitioners 3

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

• Amanda Copeland, NP

  • Gerontology Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1417490640
  Medicare reassignment Care Compare group NPD
• Shana J Mackin, NP-C

  • Acute Care Nurse Practitioner
  • Georgetown, SC
  • NPI 1538755301
  Medicare reassignment Care Compare group NPD
• Angela Carter Sheridan, FNP

  • Family Nurse Practitioner
  • Georgetown, SC
  • NPI 1043460215
  Medicare reassignment NPD

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1669878559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2591 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294406411",
            "telephone_number": "843-546-3410",
            "fax_number": "843-527-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2591 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294406411",
            "telephone_number": "843-546-3410",
            "fax_number": "843-527-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDELANDS GHS JOINT VENTURE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDELANDS GHS JOINT VENTURE LLC",
        "enumeration_date": "2014-11-05",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "STALVEY",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "DOAR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "843-546-3410"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidelands Community Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Three Hearts Caregiving Services LLC
• Thrive Family Counseling
• Tidelands Anesthesia Group LLC
• Tidelands Anesthesia Group LLC
• Tidelands GHS Joint Venture LLC
• Tidelands Home Care LLC
• Gerald R. Tiller, M.D.
• Kelsey Tiller, RD, LD
• Logan Hill Timmons, OTR/L
• Brenda Tomlin-Aubrey, CRNA

• Hospice and Palliative Medicine (Family Medicine) Physician in Georgetown, SC
• Providers in Georgetown, SC by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.