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NPI Code Detail

MEDICARE: TIDEWATER HEALTH PC

MEDICARE: TIDEWATER HEALTH PC
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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1649773789
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIDEWATER HEALTH PC
Provider Business Mailing Address
First Line : 1435 STUART ENGALS BLVD STE 101
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-7312
Country : US
Telephone Number : 843-800-5686
Fax Number : 843-800-5656
Provider Business Practice Location Address
First Line : 1435 STUART ENGALS BLVD STE 101
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-7312
Country : US
Telephone Number : 843-800-5686
Fax Number : 843-800-5656
Authorized Official
Title or Position : PRESIDENT
Name : DR. DAVID L SMITH
Credential : MD
Telephone Number : 843-800-5686
Provider Enumeration Date : 03/15/2018
Last Update Date : 05/01/2019

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Directions to “TIDEWATER HEALTH PC ” Practice Location

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