MEDICARE: FAMILY MEDICINE OF SAYEBROOK, LLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1942791090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE OF SAYEBROOK, LLC

Provider Business Mailing Address
First Line	:	106 LANSFORD PL STE 100
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-293-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 LANSFORD PL STE 100
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6979
Country	:	US
Telephone Number	:	843-293-8850
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LISA GAROZZO
Credential	:
Telephone Number	:	843-293-8850

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	05/24/2018

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