MEDICARE: GRAND STRAND REGIONAL MEDICAL 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
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1700717410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND STRAND REGIONAL MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	199 VILLAGE CENTER BLVD STE 110
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3589
Country	:	US
Telephone Number	:	615-344-9551
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 VILLAGE CENTER BLVD STE 110
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3589
Country	:	US
Telephone Number	:	615-344-9551
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARK EDWARD SIMS
Credential	:
Telephone Number	:	843-692-1104

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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