Provider Demographics
NPI:1205821634
Name:HEALTHSERV, INC
Entity Type:Organization
Organization Name:HEALTHSERV, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-497-1134
Mailing Address - Street 1:3100 DICK POND RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7286
Mailing Address - Country:US
Mailing Address - Phone:843-497-1134
Mailing Address - Fax:843-294-4111
Practice Address - Street 1:SUITE D
Practice Address - Street 2:3100 DICK POND RD
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6835
Practice Address - Country:US
Practice Address - Phone:843-497-1134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0085Medicaid