NPIMap

Organization Active NPI

Coastal Carolina Cosmetic Facial Surgery

  • Oral and Maxillofacial Surgery Clinic/Center
  • Myrtle Beach, SC
National Provider Identifier
1972081941
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
8911 Issued in SC
Legal business name
COASTAL CAROLINA COSMETIC FACIAL SURGERY
Practice address
133 Towne Centre Pkwy
Myrtle Beach, SC 29579-3493
Phone
(843) 448-1621
NPI assigned
Aug 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Authorized official

Name
Michael Johnson, DDSNPI 1427324243
Title
Managing Member
Phone
(720) 201-5801

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 8911 SC Primary

Addresses

Primary practice location

133 Towne Centre Pkwy
Myrtle Beach, SC 29579-3493

Mailing address

6210 N Ocean Blvd
Myrtle Beach, SC 29572-3300
Phone (720) 201-5801

National Provider Directory

National Provider Directory

Locations

1200 48th Ave N
Unit 101
Myrtle Beach, SC 29577
Phone (843) 449-4993

Practitioners & affiliated clinicians

Practitioners 7

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": "1533081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1972081941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 N OCEAN BLVD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295723300",
            "telephone_number": "720-201-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 TOWNE CENTRE PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793493",
            "telephone_number": "843-448-1621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA COSMETIC FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-01",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "720-201-5801",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "8911",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 10, 2019; 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.