Provider Demographics
NPI:1316992506
Name:COASTAL PLAINS PHYSICIAN ASSOCIATES
Entity type:Organization
Organization Name:COASTAL PLAINS PHYSICIAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-943-1251
Mailing Address - Street 1:595 W CAROLINA AVE
Mailing Address - Street 2:PO BOX 988
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944-4735
Mailing Address - Country:US
Mailing Address - Phone:803-943-1239
Mailing Address - Fax:803-943-1240
Practice Address - Street 1:595 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-4735
Practice Address - Country:US
Practice Address - Phone:803-943-1239
Practice Address - Fax:803-943-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25030796-6207R00000X, 207RC0001X, 208600000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3207Medicaid
SCGP3207Medicaid