Provider Demographics
NPI:1174955439
Name:ATLANTIC COAST INTEGRATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:ATLANTIC COAST INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-486-0999
Mailing Address - Street 1:1203 OLD TROLLEY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5296
Mailing Address - Country:US
Mailing Address - Phone:843-486-0999
Mailing Address - Fax:843-486-0989
Practice Address - Street 1:1203 OLD TROLLEY RD
Practice Address - Street 2:SUITE F
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5296
Practice Address - Country:US
Practice Address - Phone:843-486-0999
Practice Address - Fax:843-486-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29692208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty