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NPI Code Detail

MEDICARE: COASTAL CAROLINA BREAST CENTER LLC

MEDICARE: COASTAL CAROLINA BREAST CENTER LLC
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
1208600000XSurgery Physician

General Provider Information

NPI Number : 1295983096
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL CAROLINA BREAST CENTER LLC
Provider Business Mailing Address
First Line : 4181 HIGHWAY 17
Second Line : P O BOX 3217
City : MURRELLS INLET
State : SC
Zip : 29576-5019
Country : US
Telephone Number : 843-651-3308
Fax Number : 843-651-4629
Provider Business Practice Location Address
First Line : 4181 HIGHWAY 17
Second Line :
City : MURRELLS INLET
State : SC
Zip : 29576-5019
Country : US
Telephone Number : 843-651-3308
Fax Number : 843-651-4629
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. JOY L CIAPPETTA
Credential :
Telephone Number : 843-651-3308
Provider Enumeration Date : 09/04/2008
Last Update Date : 10/10/2008

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Directions to “COASTAL CAROLINA BREAST CENTER LLC ” Practice Location

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