Provider Demographics
NPI:1164401238
Name:DUNES MEDICAL CENTER PA
Entity Type:Organization
Organization Name:DUNES MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-449-2272
Mailing Address - Street 1:4728 JENN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5714
Mailing Address - Country:US
Mailing Address - Phone:843-449-2272
Mailing Address - Fax:843-448-2691
Practice Address - Street 1:1410 S KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-4509
Practice Address - Country:US
Practice Address - Phone:843-449-2272
Practice Address - Fax:843-448-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC61108Medicare UPIN
SC7431Medicare PIN