Healthcare Provider Details

I. General information

NPI: 1962478644
Provider Name (Legal Business Name): MYRTLE BEACH FAMILY MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

831 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-5243
  • Fax: 843-449-2333
Mailing address:
  • Phone: 843-449-5243
  • Fax: 843-449-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY A BELDEN
Title or Position: OWNER/MD
Credential: MD
Phone: 843-449-5243