Provider Demographics
NPI:1871853440
Name:CHECKUPS CLINIC LLC
Entity type:Organization
Organization Name:CHECKUPS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:PACE
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:843-349-0160
Mailing Address - Street 1:154B WACCAMAW MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8965
Mailing Address - Country:US
Mailing Address - Phone:843-349-0160
Mailing Address - Fax:843-349-0161
Practice Address - Street 1:154B WACCAMAW MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8965
Practice Address - Country:US
Practice Address - Phone:843-349-0160
Practice Address - Fax:843-349-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5970Medicaid
SCAA910B74Medicare PIN