Healthcare Provider Details

I. General information

NPI: 1720286743
Provider Name (Legal Business Name): COASTAL CAROLINA ALLERGY & ASTHMA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 CADUCEUS DR
MYRTLE BEACH SC
29588-2902
US

IV. Provider business mailing address

3516 CADUCEUS DR
MYRTLE BEACH SC
29588-2902
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-0093
  • Fax: 843-293-0096
Mailing address:
  • Phone: 843-293-0093
  • Fax: 843-293-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGP3473
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DR. MARK HUNTER SCHECKER
Title or Position: OWNER
Credential: M.D.
Phone: 843-293-0093