Provider Demographics
NPI:1508670837
Name:GRAND STRAND MOBILE WOUND CARE
Entity type:Organization
Organization Name:GRAND STRAND MOBILE WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HATHWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:617-959-4427
Mailing Address - Street 1:580 STARLIT WAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4322
Mailing Address - Country:US
Mailing Address - Phone:803-999-6863
Mailing Address - Fax:855-834-3003
Practice Address - Street 1:1297 PROFESSIONAL DR STE 201
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5713
Practice Address - Country:US
Practice Address - Phone:803-999-6863
Practice Address - Fax:855-834-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty