Provider Demographics
NPI:1467689646
Name:MOSS CREEK SPORT & SPINE INSTITUTE PROMP CARE, LLC
Entity Type:Organization
Organization Name:MOSS CREEK SPORT & SPINE INSTITUTE PROMP CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-681-5077
Mailing Address - Street 1:13 FOX DEN CT
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2561
Mailing Address - Country:US
Mailing Address - Phone:732-804-2812
Mailing Address - Fax:
Practice Address - Street 1:15 MOSS CREEK VILLAGE
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926
Practice Address - Country:US
Practice Address - Phone:732-804-2812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care