| Broadway Medical Innovation, Llc | |
|
3133 Marsh Island Dr Myrtle Beach SC 29579-5322 | |
| (734) 353-1272 | |
| Not Available |
| Full Name | Broadway Medical Innovation, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3133 Marsh Island Dr, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Victor Aguin Melendez (OWNER) |
| Authorized Official Contact | 8002947001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Medical Innovation, Llc 3133 Marsh Island Dr Myrtle Beach SC 29579-5322 Ph: () - | Broadway Medical Innovation, Llc 3133 Marsh Island Dr Myrtle Beach SC 29579-5322 Ph: (734) 353-1272 |
| NPI Number | 1467108514 |
|---|---|
| Provider Enumeration Date | 02/28/2022 |
| Last Update Date | 02/28/2022 |
| Medicare PECOS PAC ID | 4981091923 |
|---|---|
| Medicare Enrollment ID | O20220421002723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467108514 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lindsey D States |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457668386 PECOS PAC ID: 7719161207 Enrollment ID: I20110407000229 |
| Provider Name | Mary L Harding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639557531 PECOS PAC ID: 3971819608 Enrollment ID: I20150826001232 |
| Provider Name | Victor J Aguin Melendez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538563903 PECOS PAC ID: 6305160193 Enrollment ID: I20171025001236 |
| Provider Name | Matthew David Zeuschner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629684576 PECOS PAC ID: 3577977487 Enrollment ID: I20210203002283 |
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