| NAME |
MYRTLE BEACH |
| STATE |
SOUTH CAROLINA |
| STREET ADDR. 1 |
1800 AIRPARK DR |
| CITY |
MYRTLE BEACH |
| ZIP |
29577-1412 |
| OFFICIAL VA NAME |
MYRTLE BEACH PRIMARY CARE CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
MYRTLE BEACH VA CLINIC |
| ST. ADDR. 1 (MAILING) |
3381 PHILLIS BLVD |
| CITY (MAILING) |
MYRTLE BEACH |
| STATE (MAILING) |
SOUTH CAROLINA |
| ZIP (MAILING) |
29577-1533 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1821036286
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
534GB |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1821036286
-
- CODING SYSTEM: VASTANUM
- ID: 534GB
-
- CODING SYSTEM: CLIA
- ID: 42D1039072
|
