GRAND STRAND REGIONAL MEDICAL CENTER LLC

Provider Demographics

• NPI: 1083668669
• Name: GRAND STRAND REGIONAL MEDICAL CENTER LLC
• Entity Type: Organization
• Organization Name: GRAND STRAND REGIONAL MEDICAL CENTER LLC
• Other - Org Name: GRAND STRAND MEDICAL CENTER
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: ROBERT
• Authorized Official - Last Name: GRACE
• Authorized Official - Phone: 843-692-1105
• Mailing Address - Street 1: 809 82ND PARKWAY
• Mailing Address - City: MYRLTE BEACH
• Mailing Address - State: SC
• Mailing Address - Zip Code: 29572-4607
• Mailing Address - Country: US
• Mailing Address - Phone: 843-692-1000
• Mailing Address - Fax: 843-692-1109
• Practice Address - Street 1: 809 82ND PARKWAY
• Practice Address - City: MYRLTE BEACH
• Practice Address - State: SC
• Practice Address - Zip Code: 29572-4607
• Practice Address - Country: US
• Practice Address - Phone: 843-692-1000
• Practice Address - Fax: 843-692-1109
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-19
• Last Update Date: 2022-02-01

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	304727092	Medicaid
NY	719553	Medicaid
WI	80553900	Medicaid
CT	003071967	Medicaid
MO	017817909	Medicaid
MS	05252828	Medicaid
IA	0593830	Medicaid
CO	40757340	Medicaid
VA	4200853	Medicaid
	4017285	Other	BLUE CROSS
	420085	Other	HIGHMARK BLUE CROSS
CA	XHSP32315	Medicaid
	166374000	Other	DEPT OF LABOR
LA	1762610	Medicaid
WA	3016375	Medicaid
SC	347055	Medicaid
NM	62601083	Medicaid
WV	9810008000	Medicaid
RI	0420085	Medicaid
TX	177832601	Medicaid
OK	200011400A	Medicaid
FL	911683400	Medicaid
TN	0420085	Medicaid
NE	10025074600	Medicaid
IN	100375470A	Medicaid
GA	00877918X	Medicaid
MD	400323300	Medicaid
NC	4200085	Medicaid
HI	568652	Medicaid
MA	7202482	Medicaid
PA	0019712300002	Medicaid
DE	1000036024	Medicaid
KY	1600584	Medicaid
OH	411996	Medicaid
NJ	421260	Medicaid
ME	431967000	Medicaid
NC	4200085	Medicaid
NC	4200085	Medicaid