Provider Demographics
NPI:1053445817
Name:SEACOAST PEDIATRICS
Entity Type:Organization
Organization Name:SEACOAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ODOM
Authorized Official - Last Name:GEILS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-795-8100
Mailing Address - Street 1:776 DANIEL ELLIS DR
Mailing Address - Street 2:SUITE 2 A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3094
Mailing Address - Country:US
Mailing Address - Phone:843-795-8100
Mailing Address - Fax:843-722-3010
Practice Address - Street 1:776 DANIEL ELLIS DR
Practice Address - Street 2:SUITE 2 A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3094
Practice Address - Country:US
Practice Address - Phone:843-795-8100
Practice Address - Fax:843-722-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19333173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3214Medicaid
SCG69240Medicare UPIN