NPIMap

Organization Active NPI

Carolina Regional Cancer Center LLC

  • Radiation Oncology Physician
  • Myrtle Beach, SC
National Provider Identifier
1679524714
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
CAROLINA REGIONAL CANCER CENTER LLC
Practice address
4708 Oleander Drive
Myrtle Beach, SC 29577
Phone
(843) 449-9415
Fax
(843) 449-2160
NPI assigned
May 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

Name
Shaden Marzouk
Title
President
Phone
(239) 931-7254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

4708 Oleander Drive
Myrtle Beach, SC 29577

Mailing address

1419 SE 8TH Ter Ste 200
Cape Coral, FL 33990-3213
Phone (239) 931-7342

Other identifiers 6

IdentifierTypeStateIssuer
GP0968MedicaidSC
CG7705OtherRAILROAD MEDICARE
8902260MedicaidNC
503356OtherPABCBS
02260OtherNCBCBS
9620580OtherGHI

Other names 1

  • Carolina Regional Cancer Center Inc Former legal business name

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4712 Oleander Dr
Myrtle Beach, SC 29577
Phone (843) 449-9415

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1679524714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 SE 8TH TER STE 200",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339903213",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4708 OLEANDER DRIVE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29577",
            "telephone_number": "843-449-9415",
            "fax_number": "843-449-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA REGIONAL CANCER CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-13",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "MARZOUK",
        "authorized_official_first_name": "SHADEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-931-7254"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0968",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG7705",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902260",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "503356",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02260",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9620580",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Regional Cancer Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Carolina Regional Cancer Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Sep 25, 2023; 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.