| Coastal Wellness Center, Llc | |
|
4955 Highway 17 Byp S Myrtle Beach SC 29577-6684 | |
| (888) 403-2444 | |
| (855) 818-2168 |
| Full Name | Coastal Wellness Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4955 Highway 17 Byp S, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Gerald Francis Congdon (MANAGING PHYSICIAN) |
| Authorized Official Contact | 8884671117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Wellness Center, Llc 4955 Highway 17 Byp S Myrtle Beach SC 29577-6684 Ph: (888) 403-2444 | Coastal Wellness Center, Llc 4955 Highway 17 Byp S Myrtle Beach SC 29577-6684 Ph: (888) 403-2444 |
| NPI Number | 1902077266 |
|---|---|
| Provider Enumeration Date | 03/14/2008 |
| Last Update Date | 03/06/2019 |
| Medicare PECOS PAC ID | 2163723123 |
|---|---|
| Medicare Enrollment ID | O20151216000373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902077266 | NPI | - | NPPES |
| GP7038 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Gerald F Congdon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568446326 PECOS PAC ID: 0345329835 Enrollment ID: I20080508000785 |
| Provider Name | Rebecca Ann Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053638973 PECOS PAC ID: 2860523628 Enrollment ID: I20110907001594 |
| Provider Name | Regina R Evans |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1134113871 PECOS PAC ID: 8224091954 Enrollment ID: I20160629000636 |
| Provider Name | Danielle Olivia Woodley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154860369 PECOS PAC ID: 7315276664 Enrollment ID: I20190911002023 |
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