MEDICARE: PATRIOTMED OF KANSAS, P.A.

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1659216885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRIOTMED OF KANSAS, P.A.

Provider Business Mailing Address
First Line	:	101 PRATHER PARK DR STE 203
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-3701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PRATHER PARK DR STE 203
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-3701
Country	:	US
Telephone Number	:	843-796-1034
Fax Number	:

Authorized Official
Title or Position	:	CHIEF STRATEGY OFFICER
Name	:	ROBERT SCOTT THORNOCK
Credential	:
Telephone Number	:	480-369-1270

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	06/15/2026

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