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General NPI Number Information
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NPI Number | 1598742041
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Entity Type | Organization
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Legal Business Name | ADVANTAGE HEALTH CENTER, LLC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4301 HIGHWAY 544
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-6807
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Country | US
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Telephone | 843-215-5000
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Fax | 843-215-5005
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Provider Business Mailing Address
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Address Line | 4301 HIGHWAY 544
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-6807
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Country | US
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Telephone | 843-215-5000
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Fax | 843-215-5005
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DONALD W TICE
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Credential | D.O.
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Telephone | 843-215-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0584
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0708
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1072
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0847
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0364
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License Number State | SC
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