MEDICARE: SOUTHERN CROSS PSYCHIATRIC SERVICES OF SOUTH CAROLINA, INC.

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	1041C0700X	Clinical Social Worker	5455	SC

General Provider Information

NPI Number	:	1457592933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CROSS PSYCHIATRIC SERVICES OF SOUTH CAROLINA, INC.

Provider Business Mailing Address
First Line	:	1203 48TH AVE N STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5425
Country	:	US
Telephone Number	:	843-449-7105
Fax Number	:	843-449-5090

Provider Business Practice Location Address
First Line	:	1203 48TH AVE N STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5425
Country	:	US
Telephone Number	:	843-449-7105
Fax Number	:	843-449-5090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARGARET BHATT
Credential	:	MD
Telephone Number	:	800-749-2940

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	01/30/2012

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