1295795920 NPI number — DR. EDWARD R MCCARTHY D.O.

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 1295795920 NPI number — DR. EDWARD R MCCARTHY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
EDWARD
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1295795920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 LANSFORD CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-293-8850
Provider Business Mailing Address Fax Number:
843-293-8860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 LANSFORD CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-293-8850
Provider Business Practice Location Address Fax Number:
843-293-8860
Provider Enumeration Date:
03/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0584 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 204061 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 080172640 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 193125 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 153867800 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 8184888 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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