# COASTAL CAROLINA UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710136908
- **Authorized official:** MS. JILL MICHAEL APRN (NIRSE PRACTITIONER)
- **Authorized official phone:** (843) 349-6543

## Contact information

- **Practice address:** 204 UNIVERSITY BLVD, CONWAY, SC 29526-8834
- **Practice address phone:** (843) 649-6543
- **Mailing address:** 204 UNIVERSITY BLVD, CONWAY, SC 29526-8834
- **Mailing address phone:** (843) 649-6543

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 3684 | SC | Yes |

## Other

- **Enumeration date:** 09/12/2008
- **Last updated:** 09/12/2008