Healthcare Provider Details

I. General information

NPI: 1790921161
Provider Name (Legal Business Name): WOMAN'S MEDICAL CENTER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 MYRTLE TRACE DR
CONWAY SC
29526-8945
US

IV. Provider business mailing address

4728 JENN DR SUITE 104
MYRTLE BEACH SC
29577-5714
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-7216
  • Fax: 843-347-7218
Mailing address:
  • Phone: 843-236-8888
  • Fax: 843-236-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number09347
License Number StateSC

VIII. Authorized Official

Name: DR. TERRY B. LEVENSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-347-7216