Organization
COASTAL CAROLINAS INTEGRATED MEDICINE II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LA BOMMIE SAUNDERS (CREDENTIALING AND BILLING REP)
(910) 616-5770
Entity
Organization
Contact information
Practice address
416 MAIN ST, NORTH MYRTLE BEACH, SC 29582-3024
(843) 663-0933
(843) 663-0936
Mailing address
PO BOX 4563, NORTH MYRTLE BEACH, SC 29597-4563
(843) 663-0933
(843) 663-0936
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/25/2024
Last updated
09/25/2024
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