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NPI Code Detail

MEDICARE: ADVANTAGE HEALTH CENTER, LLC

MEDICARE: ADVANTAGE HEALTH 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
1207Q00000XFamily Medicine Physician0584SC
2207Q00000XFamily Medicine Physician0708SC
3207Q00000XFamily Medicine PhysicianDO1072SC
4207Q00000XFamily Medicine Physician0847SC
5207Q00000XFamily Medicine Physician0364SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00057006OTHERSCR/R MEDICARE PROVIDER ID
2CI2223OTHERR/R MEDICARE GROUP ID
5P00134805OTHERSCR/R MEDICARE PROVIDER ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4P74639OTHERSCCAROLINA CARE PLAN

General Provider Information

NPI Number : 1598742041
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANTAGE HEALTH CENTER, LLC
Provider Business Mailing Address
First Line : 4301 HIGHWAY 544
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-6807
Country : US
Telephone Number : 843-215-5000
Fax Number : 843-215-5005
Provider Business Practice Location Address
First Line : 4301 HIGHWAY 544
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-6807
Country : US
Telephone Number : 843-215-5000
Fax Number : 843-215-5005
Authorized Official
Title or Position : MANAGING PHYSICIAN
Name : DONALD W TICE
Credential : D.O.
Telephone Number : 843-215-5000
Provider Enumeration Date : 12/27/2005
Last Update Date : 04/20/2008

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Directions to “ADVANTAGE HEALTH CENTER, LLC ” Practice Location

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