Provider Demographics
NPI:1508838095
Name:CAROLINA OB-GYN LLC
Entity Type:Organization
Organization Name:CAROLINA OB-GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-651-6525
Mailing Address - Street 1:4017 HWY 17 BYPASS
Mailing Address - Street 2:PO BOX 3440
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2674
Mailing Address - Country:US
Mailing Address - Phone:843-651-6525
Mailing Address - Fax:843-357-5035
Practice Address - Street 1:4017 HWY 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-2674
Practice Address - Country:US
Practice Address - Phone:843-651-6525
Practice Address - Fax:843-357-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0739Medicaid
NC89014YRMedicaid
SC4243Medicare PIN