Healthcare Provider Details

I. General information

NPI: 1457804080
Provider Name (Legal Business Name): MCLEOD PHYSICIAN ASSOCIATES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MCLEOD HEALTH BLVD STE 202
MYRTLE BEACH SC
29579-4477
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-1201
  • Fax: 843-839-1202
Mailing address:
  • Phone: 843-777-7010
  • Fax: 843-777-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateSC

VIII. Authorized Official

Name: KENNETH D. BEASLEY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 843-777-7010