MEDICARE: DR. KIMBERLY A CECCHINI-PURGAVIE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	25MB06944300	NJ
2	208100000X	Physical Medicine & Rehabilitation Physician	1162	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1093774028	OTHER		NPI

General Provider Information

NPI Number	:	1093774028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY A CECCHINI-PURGAVIE DO

Provider Business Mailing Address
First Line	:	210 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-236-3222
Fax Number	:	843-236-3005

Provider Business Practice Location Address
First Line	:	210 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-236-3222
Fax Number	:	843-236-3005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	08/25/2014

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Directions to “ DR. KIMBERLY A CECCHINI-PURGAVIE DO” Practice Location

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