NPIMap

Organization Active NPI

Little River Medical Center, Inc.

  • Dentist
  • Myrtle Beach, SC
National Provider Identifier
1811210347
Registry record updated Mar 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4406 Issued in SC
Legal business name
LITTLE RIVER MEDICAL CENTER, INC.
Practice address
4000 Panthers Pkwy
Myrtle Beach, SC 29588-8402
Phone
(843) 236-8100
Fax
(843) 236-8103
NPI assigned
Mar 11, 2010
Organization subpart
Yes
Parent organization
LITTLE RIVER MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2010

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

Authorized official

Name
Mrs. Avangela K Criswell
Title
Business Office Director
Phone
(843) 663-1013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 4406 SC Primary

Addresses

Primary practice location

4000 Panthers Pkwy
Myrtle Beach, SC 29588-8402

Mailing address

287 Highway 90 E
Ste #5
Little River, SC 29566-7214
Phone (843) 663-1013

Other identifiers 1

IdentifierTypeStateIssuer
ZA9656MedicaidSC

National Provider Directory

National Provider Directory
Part of
Little River Medical Center Inc

Locations

4000 Panthers Pkwy
Myrtle Beach, SC 29588
Phone (843) 236-8100

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1811210347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "287 HIGHWAY 90 E",
            "address_2": "STE #5",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295667214",
            "telephone_number": "843-663-1013",
            "fax_number": "843-663-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 PANTHERS PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295888402",
            "telephone_number": "843-236-8100",
            "fax_number": "843-236-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "CRISWELL",
        "authorized_official_first_name": "AVANGELA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "843-663-1013",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "4406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9656",
            "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 Mar 16, 2010; 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.