Provider Demographics
NPI:1962596726
Name:HERITAGE MEDICAL PARTNERS
Entity type:Organization
Organization Name:HERITAGE MEDICAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-681-5305
Mailing Address - Street 1:PO BOX 21743
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29925-1743
Mailing Address - Country:US
Mailing Address - Phone:843-681-5305
Mailing Address - Fax:843-689-6946
Practice Address - Street 1:460 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2497
Practice Address - Country:US
Practice Address - Phone:843-681-5305
Practice Address - Fax:843-689-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2415Medicaid
SC6128Medicare PIN