Organization

Coastal Family Medicine

Legal Medicine in Conway, SC(View on Map)

Legal Business Name

Coastal Family Medicine

NPI Number

1548459597

NPI Type

Organization

Enumeration Date

10/16/2007

Specialties

(Taxonomies)

Code

173000000X

Primary Taxonomy

Yes

Licenses

State

South Carolina

License Number

MD 7055

Contact
Information

Purpose

Mailing
Location

Address

8014 MYRTLE TRACE DR
8014 MYRTLE TRACE DR

City

Conway
Conway

State

SC
SC

Postal Code

29526-8945
29526-8945

Country

US
US

Telephone Number

(843) 347-7224
(843) 347-7224

Authorized Official

Name

Jonathan Dieter

Title or Position

OWNER

Telephone Number

(843) 347-7224

Identifiers

Identifier

2958
PC4269

Identifier State

SC
SC

Identifier Issuer

MEDICARE PROVIDER NUMBER
MEDICAID PROVIDER NUMBER

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 10/17/2007

Provider Address

Other Legal Medicine in Conway, South Carolina:

Organization

Conway Pediatrics,pa

Conway, SC

Specialty: Legal Medicine (Primary)