Organization Name: | VILLAGE FAMILY MEDICAL |
NPI Number: | 1033558002 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES DAVID WOODCOCK (OWNER/OPERATOR) |
Mailing Address: | 3012 Newcastle Loop Myrtle Beach |
State: | SC US |
Postal Code: | 295884501 |
Phone Number: | 8434245565 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2013 |
NPI Last Update Date: | 06/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1977 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |