| Grand Strand Specialty Associates, Llc | |
|
8170 Rourk St Myrtle Beach SC 29572-4127 | |
| (843) 449-2336 | |
| Not Available |
| Full Name | Grand Strand Specialty Associates, Llc |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 8170 Rourk St, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Wayne Winney (VICE PRESIDENT OF OPERATIONS) |
| Authorized Official Contact | 8438567924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Strand Specialty Associates, Llc 8170 Rourk St Myrtle Beach SC 29572-4127 Ph: (843) 449-2336 | Grand Strand Specialty Associates, Llc 8170 Rourk St Myrtle Beach SC 29572-4127 Ph: (843) 449-2336 |
| NPI Number | 1821398512 |
|---|---|
| Provider Enumeration Date | 10/27/2010 |
| Last Update Date | 10/27/2010 |
| Medicare PECOS PAC ID | 0648451344 |
|---|---|
| Medicare Enrollment ID | O20110301000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821398512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Primary |
| Provider Name | Larry S Davidson |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1154381465 PECOS PAC ID: 6709892383 Enrollment ID: I20060612000260 |
| Provider Name | Eugene Giddens |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1932168986 PECOS PAC ID: 0648298141 Enrollment ID: I20070730000635 |
| Provider Name | Christopher G Boullion |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730201112 PECOS PAC ID: 5193918613 Enrollment ID: I20101015001284 |
| Provider Name | Leah E Cuff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801144134 PECOS PAC ID: 6800049941 Enrollment ID: I20151007002846 |
| Provider Name | Kathryn Renee Mczeke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043663750 PECOS PAC ID: 6901194042 Enrollment ID: I20161005002271 |
| Provider Name | Addison Graves Wilson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1770660060 PECOS PAC ID: 5092885277 Enrollment ID: I20170613001175 |
| Provider Name | Kevin J Pugh |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1043204704 PECOS PAC ID: 4284607250 Enrollment ID: I20191016000948 |
| Provider Name | Jesse Putman |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1144660986 PECOS PAC ID: 5496997538 Enrollment ID: I20200306002235 |
| Provider Name | James Smith |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750676524 PECOS PAC ID: 1254642366 Enrollment ID: I20200608000193 |
| Provider Name | Gabriel Phillips |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1326246836 PECOS PAC ID: 0941447569 Enrollment ID: I20210527001846 |
| Provider Name | Luke Vanells |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174015416 PECOS PAC ID: 7517212251 Enrollment ID: I20220816002175 |
| Provider Name | Tiffany Marie Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437670965 PECOS PAC ID: 4183990534 Enrollment ID: I20231228000843 |
| Provider Name | Angelina Marie Stella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932972221 PECOS PAC ID: 1850737875 Enrollment ID: I20240313001888 |
| Provider Name | Steven Warren Huder |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871585166 PECOS PAC ID: 4082656129 Enrollment ID: I20240325000211 |
| Provider Name | Glen David Subin |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1801995485 PECOS PAC ID: 8022145986 Enrollment ID: I20240816002222 |
| Provider Name | Logan Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760004923 PECOS PAC ID: 6608287982 Enrollment ID: I20241021001073 |
| Provider Name | Alon Antebi |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1639174816 PECOS PAC ID: 2668449232 Enrollment ID: I20241213003464 |
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