MEDICARE: MEREDITH MARIE DUGANICH ATC

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	2255A2300X	Athletic Trainer		SC

General Provider Information

NPI Number	:	1326031758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH MARIE DUGANICH ATC

Provider Business Mailing Address
First Line	:	646 TUPELO LN
Second Line	:	UNIT 4G
City	:	LONGS
State	:	SC
Zip	:	29568-8933
Country	:	US
Telephone Number	:	843-241-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 GARDNER LACY RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-0915
Country	:	US
Telephone Number	:	843-236-7997
Fax Number	:	843-903-7536

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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