Healthcare Provider Details

I. General information

NPI: 1598764037
Provider Name (Legal Business Name): BRIAN LOSKILL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

4615 OLEANDER DR
MYRTLE BEACH SC
29577-5741
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax: 843-497-9940
Mailing address:
  • Phone: 843-497-5929
  • Fax: 843-497-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA972
License Number StateSC

VII. Legacy identifiers

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

# 1
Identifier0308PA
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: