MEDICARE: MCLEOD PHYSICIAN ASSOCIATES II

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	363AM0700X	Medical Physician Assistant		SC
2	207RC0000X	Cardiovascular Disease Physician		SC

General Provider Information

NPI Number	:	1457804080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEOD PHYSICIAN ASSOCIATES II

Provider Business Mailing Address
First Line	:	PO BOX 3239
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-3239
Country	:	US
Telephone Number	:	843-777-7010
Fax Number	:	843-777-7006

Provider Business Practice Location Address
First Line	:	107 MCLEOD HEALTH BLVD STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4477
Country	:	US
Telephone Number	:	843-839-1201
Fax Number	:	843-839-1202

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	KENNETH D. BEASLEY
Credential	:
Telephone Number	:	843-777-7010

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	06/07/2022

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Practice Location Address:

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1164419941 — DR. WILLIAM R. GAMMON MD
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1124331863 — DUSTIN L ECK MD
Practice Location Address:

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1326594995 — MCLEOD PHYSICIAN ASSOCIATES II
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Practice Location Address:

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1184165714 — EMILY WHITEHURST FNP
Practice Location Address:

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