Provider Demographics
NPI:1801931910
Name:OCEAN SANDS PEDIATRICS
Entity type:Organization
Organization Name:OCEAN SANDS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FRANCHESCA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-543-0901
Mailing Address - Street 1:511 28TH AVE N
Mailing Address - Street 2:SUITE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3077
Mailing Address - Country:US
Mailing Address - Phone:888-543-0901
Mailing Address - Fax:800-861-9679
Practice Address - Street 1:4728 JENN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5714
Practice Address - Country:US
Practice Address - Phone:843-839-9202
Practice Address - Fax:843-467-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4771Medicaid