Provider Demographics
NPI:1659673242
Name:MURRELLS INLET WACCAMAW COMMUNITY
Entity Type:Organization
Organization Name:MURRELLS INLET WACCAMAW COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-652-8100
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2010
Mailing Address - Country:US
Mailing Address - Phone:843-652-8150
Mailing Address - Fax:843-652-8151
Practice Address - Street 1:4033 HWY 17 BYPASS
Practice Address - Street 2:STE 110
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5032
Practice Address - Country:US
Practice Address - Phone:842-652-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGETOWN PHYSICIAN SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-02
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty