MEDICARE: HILTON HEAD REGIONAL PHYSICIAN GROUP 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1821869611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILTON HEAD REGIONAL PHYSICIAN GROUP LLC

Provider Business Mailing Address
First Line	:	2085 FRONTIS PLAZA BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 HOSPITAL CENTER BLVD STE 110
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-8701
Country	:	US
Telephone Number	:	843-682-2800
Fax Number	:

Authorized Official
Title or Position	:	VP, NOVANT HEALTH SOUTH CAROLINA HO
Name	:	CURT SHAW
Credential	:
Telephone Number	:	704-384-7811

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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