NPIMap

Organization Active NPI

Coastal Carolina University

  • Clinic/Center
  • Conway, SC
National Provider Identifier
1710136908
Registry record updated Sep 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
3684 Issued in SC
Legal business name
COASTAL CAROLINA UNIVERSITY
Practice address
204 University Blvd
Conway, SC 29526-8834
Phone
(843) 649-6543
NPI assigned
Sep 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2008

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

Authorized official

Name
Ms. Jill Michael, APRN
Title
Nirse Practitioner
Phone
(843) 349-6543

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 3684 SC Primary

Addresses

Primary practice location

204 University Blvd
Conway, SC 29526-8834

Mailing address

204 University Blvd
Conway, SC 29526-8834
Phone (843) 649-6543

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221177600000",
    "number": "1710136908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 UNIVERSITY BLVD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268834",
            "telephone_number": "843-649-6543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 UNIVERSITY BLVD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268834",
            "telephone_number": "843-649-6543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-12",
        "last_updated": "2008-09-12",
        "status": "A",
        "authorized_official_last_name": "MICHAEL",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "NIRSE PRACTITIONER",
        "authorized_official_telephone_number": "843-349-6543",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": "3684",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Sep 12, 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.