1992574693 NPI number — MCLEOD PHYSICIAN ASSOCIATES II

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 1992574693 NPI number — MCLEOD PHYSICIAN ASSOCIATES II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEOD PHYSICIAN ASSOCIATES II
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:
1992574693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601743
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-1743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-646-8430
Provider Business Mailing Address Fax Number:
843-777-7102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MCLEOD HEALTH BLVD.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-646-8430
Provider Business Practice Location Address Fax Number:
843-646-8762
Provider Enumeration Date:
12/22/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BEASLEY
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE-PRESIDENT
Authorized Official Telephone Number:
843-777-7000

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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