Provider Demographics
NPI:1033558002
Name:VILLAGE FAMILY MEDICAL
Entity type:Organization
Organization Name:VILLAGE FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOODCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-424-5565
Mailing Address - Street 1:3280 PLATTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7718
Mailing Address - Country:US
Mailing Address - Phone:843-424-5565
Mailing Address - Fax:
Practice Address - Street 1:3012 NEWCASTLE LOOP
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4501
Practice Address - Country:US
Practice Address - Phone:843-424-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1285650085OtherINDIVIDUAL NPI
SC1285650085OtherINDIVIDUAL NPI