Provider Demographics
NPI:1992574693
Name:MCLEOD PHYSICIAN ASSOCIATES II
Entity type:Organization
Organization Name:MCLEOD PHYSICIAN ASSOCIATES II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-777-7000
Mailing Address - Street 1:PO BOX 601743
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1743
Mailing Address - Country:US
Mailing Address - Phone:843-646-8430
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:115 MCLEOD HEALTH BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-646-8430
Practice Address - Fax:843-646-8762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEOD HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty