Provider Demographics
NPI:1710208137
Name:GYNECOLOGY GROUP OF HILTON HEAD, LLC
Entity Type:Organization
Organization Name:GYNECOLOGY GROUP OF HILTON HEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-681-9011
Mailing Address - Street 1:4101 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4608
Mailing Address - Country:US
Mailing Address - Phone:843-681-9011
Mailing Address - Fax:843-681-9013
Practice Address - Street 1:4101 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-4608
Practice Address - Country:US
Practice Address - Phone:843-681-9011
Practice Address - Fax:843-681-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18140207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD481653Medicare UPIN