ST PAUL'S MEDICAL GROUP, INC (NPI# 1740402130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740402130 |
| Entity Type | Organization |
| Organization Name | ST PAUL'S MEDICAL GROUP, INC |
| Other Organization Name | ST PAULS MEDICAL GROUP |
| Practice Address |
7610 Highway 164 Hollywood SC 29449 |
| Mailing Address |
Po Box 1355 Hollywood SC 29449-1355 |
| Practice Telephone | 8438898018 |
| Practice Fax Number | 8438899133 |
| Mailing Telephone | 8438898018 |
| Mailing Fax Number | 8438899133 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2009-12-28 |
| Authorized Official Name | MARSHA GAY DELAVAN (PRESIDENT) |
| Authorized Official Telephone | 8438898018 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP2603 | 05 | |
| SC | CLIA NUMBER | 42D0968299 | 01 |
| Other Name | Type Code |
|---|---|
| ST PAULS MEDICAL GROUP | Doing Business As Name - Organization |
| Street Address |
7610 HIGHWAY 164 |
| City | HOLLYWOOD |
| State | SC |
| Zip Code | 29449 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649331547 | Susan Boineau | Technician/Technologist | 7610 Highway 164, Hollywood, SC 29449-5934 | 2006-12-13 |
| 1568642783 | St. Paul's Family Eye Care | Technician/Technologist | 7610 Highway 164, Hollywood, SC 29449-5934 | 2007-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164898151 | Melissa Macher | Dietitian, Registered | 5033 Wapiti Way, Hollywood, SC 29449 | 2015-08-13 |
| 1134453517 | Piggly Wiggly Hollywood, Inc. | Durable Medical Equipment & Medical Supplies | Highway 162, Hollywood, SC 29449 | 2009-10-01 |
| 1316004633 | Preferred Care Pharmaceutical Services Inc | Pharmacy | 4794 A Hwy 162, Hollywood, SC 29449 | 2007-01-03 |
| 1831157726 | Preferred Care Pharmaceutical Services Inc. | Pharmacy | 4794-a Highway 162, Hollywood, SC 29449 | 2006-05-02 |
| 1316382104 | Charlotte Davis | Registered Nurse | 8548 Willtown Rd, Yonges Island, SC 29449-5515 | 2013-05-07 |
| 1477004133 | Fetter Health Care Network Inc | Clinic/Center | 8548 Willtown Rd, Hollywood, SC 29449-5515 | 2016-10-18 |
| 1891342432 | Kaylee Mcdaniel | Occupational Therapy Assistant | 4879 Coach Rd, Hollywood, SC 29449-5521 | 2019-08-19 |
| 1689019465 | Tamela S Kizer | Registered Nurse | 7184 Highway 162, Hollywood, SC 29449-5603 | 2013-05-07 |
| 1922327832 | Andrea Hamilton | Specialist | 7986 Highway 162, Hollywood, SC 29449-5607 | 2010-05-18 |
| 1982085767 | Guardian Pharmacy of Sc One LLC | Pharmacy | 4794a Highway 162, Hollywood, SC 29449-5740 | 2015-06-17 |
| Find all providers in zip 29449 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578108551 | Rambam Medical Inc | Clinic/Center | 7081 Taft St, Hollywood, FL 33024-3803 | 2019-11-13 |
| 1386293785 | Mj Doc Health Center 2 Inc | Clinic/Center | 6101 Hollywood Blvd, Hollywood, FL 33024-7937 | 2019-09-09 |
| 1316422462 | Alcasias Corp | Clinic/Center | 2719 Hollywood Blvd Ste A-1512, Hollywood, FL 33020-4821 | 2018-09-25 |
| 1447610712 | Family Pain & Health Center, LLC. | Clinic/Center | 6222 Johnson St, Hollywood, FL 33024-5932 | 2016-03-01 |
| 1104247725 | South Florida Spine and Wellness Center, Inc. | Clinic/Center | 6908 Stirling Rd, Hollywood, FL 33024-1839 | 2013-12-27 |
| 1679847990 | Stirling Medical Center, Inc | Clinic/Center | 5892 Stirling Rd Ste 2, Hollywood, FL 33021-1541 | 2012-03-05 |
| 1851623573 | Fisioterapia Hollywodd Medical | Clinic/Center | 115 S 17th Ave, Hollywood, FL 33020-6801 | 2010-02-04 |
| 1609104439 | Quality Care Pl | Clinic/Center | 3800 S Ocean Dr Ste G3, Hollywood, FL 33019-2906 | 2009-12-07 |
| 1134350309 | Broward Physician Therapy Corp | Clinic/Center | 2440 N 59th Ter, Hollywood, FL 33021-3265 | 2009-08-05 |
| 1083881874 | Associates for Psychological Services, Inc. | Clinic/Center | 940 S Federal Hwy, Hollywood, FL 33020-6024 | 2008-05-12 |
| Find all providers in HOLLYWOOD | ||||
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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.