MEDICARE: HISHAM IBRAHIM BASSIOUNI PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50001725	OH
2	363A00000X	Physician Assistant	PA3422	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00385946	OTHER		RR ERIE

General Provider Information

NPI Number	:	1205883105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HISHAM IBRAHIM BASSIOUNI PAC

Provider Business Mailing Address
First Line	:	5046 HIGHWAY 17 BYP S STE 103
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4503
Country	:	US
Telephone Number	:	843-668-4104
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 HIGHWAY 17 BYP S STE 103
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4503
Country	:	US
Telephone Number	:	843-668-4104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	04/08/2025

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Directions to “ HISHAM IBRAHIM BASSIOUNI PAC” Practice Location

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