| Organization Name: | COASTAL CAROLINA PRIMARY CARE, LLC |
| NPI Number: | 1164783643 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WAYNE O WHINNEY (AUTHORIZED OFFICIAL) |
| Mailing Address: | 106 W Main St Moncks Corner |
| State: | SC US |
| Postal Code: | 294612601 |
| Phone Number: | 8437611995 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2012 |
| NPI Last Update Date: | 05/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |