| Coastal Carolina Infectious Disease, Llc | |
|
1110 London St Ste 102 Myrtle Beach SC 29577 | |
| (843) 668-2376 | |
| (843) 748-0613 |
| Full Name | Coastal Carolina Infectious Disease, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1110 London St Ste 102, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Marlene Thornhill (BILLING MANAGER) |
| Authorized Official Contact | 8436682376 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Carolina Infectious Disease, Llc 1110 London St Ste 102 Myrtle Beach SC 29577-5799 Ph: (843) 668-2376 | Coastal Carolina Infectious Disease, Llc 1110 London St Ste 102 Myrtle Beach SC 29577 Ph: (843) 668-2376 |
| NPI Number | 1265898191 |
|---|---|
| Provider Enumeration Date | 01/07/2016 |
| Last Update Date | 05/17/2018 |
| Medicare PECOS PAC ID | 1557667268 |
|---|---|
| Medicare Enrollment ID | O20160307001210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265898191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (South Carolina) | Primary |
| Provider Name | Yama Osmanzai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376593673 PECOS PAC ID: 3072588904 Enrollment ID: I20150910001824 |
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