Healthcare Provider Details

I. General information

NPI: 1780020446
Provider Name (Legal Business Name): SOUTHERN MYRTLE INPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PARKWAY
MYRTLE BEACH SC
29572
US

IV. Provider business mailing address

PO BOX 37765
PHILADELPHIA PA
19101-5065
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-1000
  • Fax:
Mailing address:
  • Phone: 800-355-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY J. BYRNE
Title or Position: PRESIDENT
Credential:
Phone: 800-507-8874