MEDICARE: THRASHER PSYCHOTHERAPEUTICS PA

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	2084P0800X	Psychiatry Physician	12036	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619167533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRASHER PSYCHOTHERAPEUTICS PA

Provider Business Mailing Address
First Line	:	1113 48TH AVE N
Second Line	:	SUITE 117
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5441
Country	:	US
Telephone Number	:	843-449-7105
Fax Number	:	843-449-5090

Provider Business Practice Location Address
First Line	:	1113 48TH AVE N
Second Line	:	SUITE 117
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5441
Country	:	US
Telephone Number	:	843-449-7105
Fax Number	:	843-449-5090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES WINFIELD THRASHER JR.
Credential	:	M.D.
Telephone Number	:	843-449-7105

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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