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Organization
ADVANTAGE HEALTH CENTER, LLC
Active
Organization
ADVANTAGE HEALTH CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W TICE D.O. (MANAGING PHYSICIAN)
(843) 215-5000
Entity
Organization
Contact information
Practice address
4301 HIGHWAY 544, MYRTLE BEACH, SC 29588-6807
(843) 215-5000
(843) 215-5005
Mailing address
4301 HIGHWAY 544, MYRTLE BEACH, SC 29588-6807
(843) 215-5000
(843) 215-5005
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0364
SC
207Q00000X
Family Medicine Physician
0584
SC
207Q00000X
Family Medicine Physician
0708
SC
207Q00000X
Family Medicine Physician
0847
SC
207Q00000X
Family Medicine Physician
DO1072
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI2223
R/R MEDICARE GROUP ID
—
05
—
GP1373
—
SC
01
—
P00057006
R/R MEDICARE PROVIDER ID
SC
01
—
P00134805
R/R MEDICARE PROVIDER ID
SC
01
—
P74639
CAROLINA CARE PLAN
SC
Enumeration date
12/27/2005
Last updated
04/20/2008
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