Provider Demographics
NPI:1932261740
Name:BEACH MEDICAL LLC
Entity type:Organization
Organization Name:BEACH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GREICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-786-9986
Mailing Address - Street 1:PO BOX 1392
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-1392
Mailing Address - Country:US
Mailing Address - Phone:912-786-9986
Mailing Address - Fax:912-786-9987
Practice Address - Street 1:602 FIRST ST
Practice Address - Street 2:
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328
Practice Address - Country:US
Practice Address - Phone:912-786-9986
Practice Address - Fax:912-786-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA083786261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB28620Medicare UPIN
08CBBNTMedicare ID - Type Unspecified