Provider Demographics
NPI:1629267646
Name:SOUTHCOAST FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:SOUTHCOAST FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-706-5995
Mailing Address - Street 1:PO BOX 3980
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-3980
Mailing Address - Country:US
Mailing Address - Phone:843-706-5995
Mailing Address - Fax:843-706-5996
Practice Address - Street 1:23 PLANTATION PARK DR
Practice Address - Street 2:SUITE 403
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6038
Practice Address - Country:US
Practice Address - Phone:843-706-5995
Practice Address - Fax:843-706-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD19063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8144Medicare PIN