Provider Demographics
NPI:1366546608
Name:MAGNOLIA OB-GYN LLC OF MYRTLE BEACH
Entity type:Organization
Organization Name:MAGNOLIA OB-GYN LLC OF MYRTLE BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-449-5848
Mailing Address - Street 1:8203 NIGELS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4177
Mailing Address - Country:US
Mailing Address - Phone:843-449-5848
Mailing Address - Fax:843-692-0841
Practice Address - Street 1:8203 NIGELS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4177
Practice Address - Country:US
Practice Address - Phone:843-449-5848
Practice Address - Fax:843-692-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty