Provider Demographics
NPI:1497944219
Name:COASTAL CAROLINA PRIMARY CARE OF MURRELLS INLET
Entity Type:Organization
Organization Name:COASTAL CAROLINA PRIMARY CARE OF MURRELLS INLET
Other - Org Name:PALMETTO INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-651-0044
Mailing Address - Street 1:4111 MURRELLS INLET RD
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6208
Mailing Address - Country:US
Mailing Address - Phone:843-651-0444
Mailing Address - Fax:843-357-0766
Practice Address - Street 1:4111 MURRELLS INLET RD
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6208
Practice Address - Country:US
Practice Address - Phone:843-651-0044
Practice Address - Fax:843-357-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6926Medicare PIN