Provider Demographics
NPI:1326073370
Name:NORTH MYRTLE BEACH INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NORTH MYRTLE BEACH INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUEHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-663-2100
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29597-0900
Mailing Address - Country:US
Mailing Address - Phone:843-663-2100
Mailing Address - Fax:843-663-2102
Practice Address - Street 1:2021 N MYRTLE POINT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2224
Practice Address - Country:US
Practice Address - Phone:843-663-2100
Practice Address - Fax:843-663-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3688Medicaid
SCG03919Medicare UPIN
SCGP3688Medicaid