Provider Demographics
NPI:1295392132
Name:VENUS GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:VENUS GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-268-2525
Mailing Address - Street 1:8203 NIGELS DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4179
Mailing Address - Country:US
Mailing Address - Phone:843-268-2525
Mailing Address - Fax:843-449-7313
Practice Address - Street 1:8203 NIGELS DR STE 203
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4179
Practice Address - Country:US
Practice Address - Phone:843-268-2525
Practice Address - Fax:843-449-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty