Healthcare Provider Details

I. General information

NPI: 1124481296
Provider Name (Legal Business Name): VERITAS EXECUTIVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5046 HIGHWAY 17 BYP S SUITE 100
MYRTLE BEACH SC
29588-4503
US

IV. Provider business mailing address

5046 HIGHWAY 17 BYP S SUITE 100
MYRTLE BEACH SC
29588-4503
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-5100
  • Fax: 843-293-5100
Mailing address:
  • Phone: 843-293-5100
  • Fax: 843-293-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14089
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14089
License Number StateSC

VIII. Authorized Official

Name: MR. SHAWN EVAN HALLINAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-293-5100