Provider Demographics
NPI:1245623792
Name:BLACK CREEK MEDICAL CONSULTANTS, LLC
Entity type:Organization
Organization Name:BLACK CREEK MEDICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:DYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1843-568-2363
Mailing Address - Street 1:696 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4782
Mailing Address - Country:US
Mailing Address - Phone:843-383-5312
Mailing Address - Fax:843-383-4516
Practice Address - Street 1:696 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4782
Practice Address - Country:US
Practice Address - Phone:843-383-5312
Practice Address - Fax:843-383-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27632207YX0602X, 207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty