Provider Demographics
NPI:1871890665
Name:PHYSICIAN PRACTICE MANAGEMENT, LLC
Entity type:Organization
Organization Name:PHYSICIAN PRACTICE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-902-5134
Mailing Address - Street 1:PO BOX 70667
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0030
Mailing Address - Country:US
Mailing Address - Phone:843-902-5134
Mailing Address - Fax:843-497-7775
Practice Address - Street 1:1021 CIPRIANA DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4621
Practice Address - Country:US
Practice Address - Phone:843-497-7771
Practice Address - Fax:843-497-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC58272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty