1083668669 NPI number — GRAND STRAND REGIONAL MEDICAL CENTER LLC

Table of content: (NPI 1083668669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083668669 NPI number — GRAND STRAND REGIONAL MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND STRAND REGIONAL MEDICAL CENTER LLC
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:
6
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:
1083668669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 82ND PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRLTE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29572-4607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-692-1000
Provider Business Mailing Address Fax Number:
843-692-1109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 82ND PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRLTE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-692-1000
Provider Business Practice Location Address Fax Number:
843-692-1109
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRACE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
843-692-1105

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 003071967 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347055 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411996 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4200085 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62601083 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 719553 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000036024 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80553900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9810008000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4017285 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 420085 . This is a "HIGHMARK BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0019712300002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0420085 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0420085 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1600584 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177832601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200011400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00877918X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025074600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100375470A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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