Provider Demographics
NPI:1619167533
Name:THRASHER PSYCHOTHERAPEUTICS PA
Entity Type:Organization
Organization Name:THRASHER PSYCHOTHERAPEUTICS PA
Other - Org Name:THRASHER & ASSOCIATES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WINFIELD
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-449-7105
Mailing Address - Street 1:1113 48TH AVE N
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5441
Mailing Address - Country:US
Mailing Address - Phone:843-449-7105
Mailing Address - Fax:843-449-5090
Practice Address - Street 1:1113 48TH AVE N
Practice Address - Street 2:SUITE 117
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5441
Practice Address - Country:US
Practice Address - Phone:843-449-7105
Practice Address - Fax:843-449-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC120363Medicaid
SCB91395Medicare UPIN