GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A. – NPI #1588614192
Pediatrics

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A. is a provider located in MYRTLE BEACH, SC. NPPES has assigned the NPI number 1588614192 to GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A. on May 12, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2080A0000X from the Health Care Provider Taxonomy code set, which is classified as Pediatrics, specializing in Adolescent Medicine

The NPI profile was previously updated about 12 years ago on Feb 25, 2014. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A. below.

NPI Profile for
GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.

NPI Number
1588614192
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.
Primary location
8120 ROURK ST
MYRTLE BEACH, SC 29572-4127
Phone: (843) 449-1438 Fax: (843) 286-1349
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
THOMAS PETRUSICK
OWNER/PHYSICIAN
Phone: (843) 449-1438
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2080A0000X
- Pediatrics / Adolescent Medicine (Primary)
SC 7085

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.