MEDICARE: OCEAN SANDS PEDIATRICS

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	208000000X	Pediatrics Physician	27747	SC

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	:	1801931910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN SANDS PEDIATRICS

Provider Business Mailing Address
First Line	:	511 28TH AVE N
Second Line	:	SUITE C
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3077
Country	:	US
Telephone Number	:	888-543-0901
Fax Number	:	800-861-9679

Provider Business Practice Location Address
First Line	:	4728 JENN DR
Second Line	:	SUITE 103
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5714
Country	:	US
Telephone Number	:	843-839-9202
Fax Number	:	843-467-2560

Authorized Official
Title or Position	:	MD
Name	:	FRANCHESCA DAWN BROWN
Credential	:	MD
Telephone Number	:	888-543-0901

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	02/07/2008

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