| NPI | 1992123822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MCKAY Officer/Director 843-669-1010 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: SC 11313) |
| Additional Taxonomies | 111NR0400X (Licence: SC 2474) |
| 207Q00000X Family Medicine (Licence: SC 11313) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: SC 2474) | |
| 363L00000X Nurse Practitioner (Licence: SC 4108) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |