Healthcare Provider Details

I. General information

NPI: 1295074276
Provider Name (Legal Business Name): DOCTORS CARE SC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIDDLEBURG DR
MYRTLE BEACH SC
29579-3408
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2619
US

V. Phone/Fax

Practice location:
  • Phone: 843-903-6650
  • Fax: 843-903-0758
Mailing address:
  • Phone: 803-758-2600
  • Fax: 803-253-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierGP0890
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DR. SHELLEY JANSSEN
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 803-782-4278