MEDICARE: COASTAL PODIATRY ASSOCIATES 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	213ES0103X	Foot & Ankle Surgery Podiatrist

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	:	1710948716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL PODIATRY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	8141 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4128
Country	:	US
Telephone Number	:	843-449-8079
Fax Number	:	843-497-6147

Provider Business Practice Location Address
First Line	:	8141 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4128
Country	:	US
Telephone Number	:	843-449-8079
Fax Number	:	843-497-6147

Authorized Official
Title or Position	:	DOCTOR
Name	:	SCOTT A HAMILTON
Credential	:	DPM
Telephone Number	:	843-449-8079

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	08/19/2014

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