1013937226 NPI number — ASSOCIATED MEDICAL SPECIALISTS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013937226 NPI number — ASSOCIATED MEDICAL SPECIALISTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED MEDICAL SPECIALISTS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COASTAL CANCER CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013937226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8121 ROURK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29572-4128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-692-5000
Provider Business Mailing Address Fax Number:
843-692-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPPLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28462-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-755-7509
Provider Business Practice Location Address Fax Number:
843-692-5015
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAUDEL
Authorized Official First Name:
VIJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
843-692-5000

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  200100151 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPB047 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89015KV , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com