| Tidelands Health Gastroenterology | |
|
1011 N Fraser St Georgetown SC 29440 | |
| (843) 527-3428 | |
| (843) 546-8216 |
| Full Name | Tidelands Health Gastroenterology |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1011 N Fraser St, Georgetown, South Carolina |
| Authorized Official Name and Position | Elizabeth Sutherland Ward (EVP & CFO) |
| Authorized Official Contact | 8435277102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidelands Health Gastroenterology Po Box 421718 Georgetown SC 29442-4203 Ph: (843) 520-8883 | Tidelands Health Gastroenterology 1011 N Fraser St Georgetown SC 29440 Ph: (843) 527-3428 |
| NPI Number | 1093139420 |
|---|---|
| Provider Enumeration Date | 02/05/2014 |
| Last Update Date | 06/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093139420 | NPI | - | NPPES |
| GP8837 | Medicaid | SC | |
| GP6485 | Medicaid | SC | |
| GP8109 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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