Provider Demographics
NPI:1538263272
Name:WACCAMAW PRIMARY CARE,LLC
Entity type:Organization
Organization Name:WACCAMAW PRIMARY CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:DOWD
Authorized Official - Last Name:MCIVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-234-4362
Mailing Address - Street 1:660 SINGLETON RIDGE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526
Mailing Address - Country:US
Mailing Address - Phone:843-234-4362
Mailing Address - Fax:
Practice Address - Street 1:660 SINGLETON RIDGE
Practice Address - Street 2:SUITE A
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-234-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22160261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH28479Medicare UPIN