Healthcare Provider Details

I. General information

NPI: 1861525404
Provider Name (Legal Business Name): BEACH MEDICAL CARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 S CROATAN HWY UNIT 1B
NAGS HEAD NC
27959-8811
US

IV. Provider business mailing address

PO BOX 2089
KITTY HAWK NC
27949-2089
US

V. Phone/Fax

Practice location:
  • Phone: 252-261-4187
  • Fax: 252-261-5182
Mailing address:
  • Phone: 252-261-4187
  • Fax: 252-261-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0190118
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number29449
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES S. WILKINSON X
Title or Position: PRESIDENT
Credential: M.D.
Phone: 252-261-4187