Provider Demographics
NPI:1497734578
Name:INLET MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:INLET MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-651-4111
Mailing Address - Street 1:BOX 107
Mailing Address - Street 2:4728 JENN DR
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5714
Mailing Address - Country:US
Mailing Address - Phone:843-236-8888
Mailing Address - Fax:843-236-5088
Practice Address - Street 1:912 INLET SQUARE DRIVE
Practice Address - Street 2:
Practice Address - City:MURRELLS INLT
Practice Address - State:SC
Practice Address - Zip Code:29576-5017
Practice Address - Country:US
Practice Address - Phone:843-651-4111
Practice Address - Fax:843-651-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12346174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0461Medicaid
SCGP0461Medicaid