MEDICARE: MRS. MEGAN ELVIS HASELDEN PA-C

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	363A00000X	Physician Assistant	MPA.1931 TL	SC

General Provider Information

NPI Number	:	1659717452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN ELVIS HASELDEN PA-C

Provider Business Mailing Address
First Line	:	580 MARY LOU AVE
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-6146
Country	:	US
Telephone Number	:	843-241-3829
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6807
Country	:	US
Telephone Number	:	843-652-8100
Fax Number	:	843-652-8122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	02/17/2014

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