| East Coast Retina, Pa | |
|
8609 Montague Ln Myrtle Beach SC 29588-4504 | |
| (843) 215-3363 | |
| (843) 215-7201 |
| Full Name | East Coast Retina, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 8609 Montague Ln, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Stephen J Phillips (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8432153363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Coast Retina, Pa 8609 Montague Ln Myrtle Beach SC 29588-4504 Ph: (843) 215-3363 | East Coast Retina, Pa 8609 Montague Ln Myrtle Beach SC 29588-4504 Ph: (843) 215-3363 |
| NPI Number | 1730138157 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 09/26/2011 |
| Medicare PECOS PAC ID | 7719998418 |
|---|---|
| Medicare Enrollment ID | O20060509000806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730138157 | NPI | - | NPPES |
| GP4339 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 26821 (South Carolina) | Primary |
| Provider Name | Stephen J Phillips |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1265499693 PECOS PAC ID: 3870575848 Enrollment ID: I20040603000424 |
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