1093075939 NPI number — HORRY-GEORGETOWN TECHNICAL COLLEGE

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 1093075939 NPI number — HORRY-GEORGETOWN TECHNICAL COLLEGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORRY-GEORGETOWN TECHNICAL COLLEGE
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:
Provider Other Organization Name Type Code:
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:
1093075939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 261966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29528-6066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-349-5279
Provider Business Mailing Address Fax Number:
843-349-7532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 PAMPAS DR
Provider Second Line Business Practice Location Address:
BLDG. 1000
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29577-5168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-349-5279
Provider Business Practice Location Address Fax Number:
843-349-7532
Provider Enumeration Date:
05/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RENDER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
NOEL
Authorized Official Title or Position:
DENTIST, DEAN OF ACADEMIC AFFAIRS
Authorized Official Telephone Number:
843-477-2171

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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