Healthcare Provider Details

I. General information

NPI: 1063245660
Provider Name (Legal Business Name): SIMON MYERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 82ND PKWY
MYRTLE BEACH SC
29572-4612
US

IV. Provider business mailing address

PO BOX 3439
NORTH MYRTLE BEACH SC
29582-0439
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax:
Mailing address:
  • Phone: 843-497-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6004
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: