MEDICARE: TIDELANDS HEALTH

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1134002439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDELANDS HEALTH

Provider Business Mailing Address
First Line	:	6723 GENESIS DRIVE
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576
Country	:	US
Telephone Number	:	631-327-8894
Fax Number	:	631-327-8894

Provider Business Practice Location Address
First Line	:	11916 HIGHWAY 707 STE D
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-9610
Country	:	US
Telephone Number	:	843-652-8450
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	TYLER ELISE KELLY
Credential	:
Telephone Number	:	631-327-8894

Provider Enumeration Date	:	07/26/2025
Last Update Date	:	07/26/2025

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Directions to “TIDELANDS HEALTH ” Practice Location

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