ANGELIC PRIMARY MEDICINE OF SC LLC NPI 1730752015

NPI Information

NPI: 1730752015
Provider Name: ANGELIC PRIMARY MEDICINE OF SC, LLC
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 31D2195398

Address:
923B MEDICAL CIR
MYRTLE BEACH, SC
ZIP 29572
Phone: (854) 444-9998
Get Directions

ANGELIC PRIMARY MEDICINE OF SC, LLC is a primary care nurse practitioner in Myrtle Beach, SC. ANGELIC PRIMARY MEDICINE OF SC, LLC NPI is 1730752015. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

923B MEDICAL CIR
MYRTLE BEACH, SC
ZIP 29572-116
Phone: (854) 444-9998
Fax: (843) 353-2495

The provider's authorized official is Janet Gibson .
The authorized official title is Owner and has the following contact phone number (609) 464-1135.

The CLIA number assigned to this NPI record is 31D2195398 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/23/2021 and was last updated on 10/13/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	24726	OTHER	SOUTH CAROLINA	LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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