MR. JORGE L CORDOVA - RUIZ (NPI# 1477967545) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477967545 |
| Entity Type | Individual |
| Full Name | MR. JORGE L CORDOVA - RUIZ |
| Credential | M.D |
| Practice Address |
3381 Phillis Blvd Myrtle Beach SC 29577 |
| Mailing Address |
3381 Phillis Blvd Myrtle Beach SC 29577-1560 |
| Practice Telephone | 8434770177 |
| Practice Fax Number | 8432322428 |
| Mailing Telephone | 8434770177 |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2018-07-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 019114 | PR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PR | 1477967545 | 1477967545 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| Sergio Cuevas Bustamante Street, #550, Ave Domenech, San Juan, PR 00918 | 7877588383 | 7877639758 |
| Street Address |
3381 PHILLIS BLVD |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29577 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659341287 | Jose Luis Morales Vazquez | Family Medicine | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2006-01-25 |
| 1104328970 | Melissa Ann Green | Dietitian, Registered | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2018-03-07 |
| 1144672791 | Emily Heubel | Pharmacist | 3381 Phillis Blvd, Myrtle Beach, SC 29577 | 2016-07-07 |
| 1255735445 | Dara Ann Williams | Psychologist | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2014-10-16 |
| 1801209226 | Eric Biscoglio | Psychologist | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2014-06-03 |
| 1952657843 | Jacqueline D Thomas | Nurse Practitioner | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2012-07-28 |
| 1366721110 | James Michael Caruso | Optometrist | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2011-08-10 |
| 1659664233 | Michael Behrens | Pharmacist | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2011-05-16 |
| 1326372657 | Skye Leigh King | Social Worker | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2009-09-18 |
| 1811180805 | Joyce A. Greeno | Licensed Practical Nurse | 3381 Phillis Blvd, Myrtle Beach, SC 29577 | 2007-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124536446 | Well Care Home Health of The Lowcountry | Home Health | 1039 44th Ave N Ste 101, Myrtle Beach, SC 29577 | 2018-01-22 |
| 1518470913 | Guillot Enterprises, LLC | Hearing Instrument Specialist | 1294 Professional Dr., Suite C, Myrtle, SC 29577 | 2017-11-08 |
| 1598288227 | Ryan Shepherd | Pharmacist | 1705 South Kings Highway, Myrtle Beach, SC 29577 | 2017-07-25 |
| 1184176554 | Shannon Long | Counselor | 1293 Professional Drive, Suite D Office 222, Myrtle Beach, SC 29577 | 2016-11-01 |
| 1265898191 | Coastal Carolina Infectious Disease, LLC | Internal Medicine | 1110 London St Ste 102, Myrtle Beach, SC 29577 | 2016-01-07 |
| 1548639933 | Susan Lang | Social Worker | 1273 Professional Dr., Suite A #104, Myrtle Beach, SC 29577 | 2015-09-16 |
| 1043600893 | Kenneth Edward Smith | Counselor | 1125 48th Avenue North, Myrtle Beach, SC 29577 | 2015-02-02 |
| 1902203615 | Sc Nursing Services LLC | Home Infusion | 1297 Professional Drive, Suite 201 C3, Myrtle Beach, SC 29577 | 2014-11-24 |
| 1881007946 | Intercoastal Endo, PC | Dentist | 4382 Oleander Dr, Myrtle Beach, SC 29577 | 2014-06-06 |
| 1891115739 | Julie Hite | Pharmacist | 540 Seaboard Street, Myrtle Beach, SC 29577 | 2014-04-18 |
| Find all providers in zip 29577 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346365541 | Fred Paul Norman | General Practice | 7751 N Kings Hwy, Suite A, Myrtle Beach, SC 29572-3005 | 2007-03-20 |
| 1295074276 | Doctors Care Sc, Pa | General Practice | 200 Middleburg Dr, Myrtle Beach, SC 29579-3408 | 2013-02-11 |
| 1346564424 | Awaremed Wholistic Urgent Care Pllc | General Practice | 4710 Oleander Drive, Myrtle Beach, SC 29577-5898 | 2010-03-18 |
| 1235250325 | Ramon Colon Bermudez | General Practice | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2007-04-03 |
| 1902984412 | Diana M Vargas | General Practice | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2006-11-01 |
| 1427168376 | Jessica Vanessa Romero | General Practice | 3381 Phillis Blvd, Myrtle Beach, SC 29577-1560 | 2006-08-30 |
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|---|---|---|---|---|
| 1053912253 | Life Essentials Health Center LLC | General Practice | 1501 N Highway 17 Unit H, Mount Pleasant, SC 29464-3342 | 2020-11-04 |
| 1710591706 | Madhuri Khadka | General Practice | 427 Galbreath Ct, Fort Mill, SC 29708-0176 | 2020-09-07 |
| 1255945754 | Escobedo Advanced Healthcare Solutions LLC | General Practice | 121 Sparkleberry Crossing Rd Ste 200, Columbia, SC 29229-8639 | 2020-09-02 |
| 1306326640 | Orange Cut Rate Drug Store, Inc | General Practice | 1326 Grove Park Dr, Orangeburg, SC 29115 | 2018-08-16 |
| 1841704244 | Modern Concepts, LLC | General Practice | 1808 Second Baxter Xing Ste 108, Fort Mill, SC 29708 | 2017-11-21 |
| 1245744937 | Carolina Healthchoice of Greenville, LLC | General Practice | 274 Commonwealth Dr Ste B, Greenville, SC 29615-4872 | 2017-11-17 |
| 1861937377 | Doctors Care Sc, Pa | General Practice | 8384 Charlotte Highway, Indian Land, SC 29707-6532 | 2016-12-20 |
| 1790138014 | Beaufort-jasper-hampton Comprehensive Health Services Inc. | General Practice | 2210-b Mossy Oaks Rd., Port Royal, SC 29935-1046 | 2016-07-21 |
| 1659726438 | Inspire Medical Services | General Practice | 104 Berkeley Square Ln, Ste 63, Goose Creek, SC 29445-2958 | 2016-04-28 |
| 1609240910 | Eating Recovery Center-the Carolinas | General Practice | 12 Maple Tree Court, Suite 101, Greenville, SC 29615-4079 | 2015-11-24 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29577 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.