MEDICARE: MYRTLE BEACH TREATMENT SPECIALISTS 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	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1922676998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRTLE BEACH TREATMENT SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1607 EXECUTIVE AVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-6501
Country	:	US
Telephone Number	:	843-712-7316
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 EXECUTIVE AVE
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-6501
Country	:	US
Telephone Number	:	843-712-7316
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. ANDREW SIMPSON
Credential	:	DO
Telephone Number	:	843-712-7316

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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