COASTAL MED SPA, LLC
NPI 1134090582
Preventive Medicine - Public Health & General Preventive Medicine in Myrtle Beach, SC

Q: What is Coastal Med Spa, LLC's NPI number?

The NPI number for Coastal Med Spa, LLC is 1134090582. It was assigned to this organization in the NPPES registry on September 17, 2025.

Q: What is Coastal Med Spa, LLC's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Public Health & General Preventive Medicine, with taxonomy code 2083P0901X.

Active since September 17, 2025

4006 POSTAL WAY UNIT A, MYRTLE BEACH, SC 29579(843) 796-1769 Get Directions Write a Review

NPPES record last updated: September 17, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Coastal Med Spa, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COASTAL MED SPA, LLC (NPI 1134090582) is a healthcare organization registered as a public health & general preventive medicine in Myrtle Beach, South Carolina and active in the NPI registry since September 2025. The organization lists Laura Rice, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1134090582

Entity TypeOrganization

Primary Taxonomy2083P0901X

Legal Business NameCOASTAL MED SPA, LLC

Location Address4006 POSTAL WAY UNIT AMyrtle Beach, SC 29579-3527

Mailing Address4006 Postal Way Unit AMyrtle Beach, SC 29579-3527 · (843) 796-1769

Phone(843) 796-1769

Organization SubpartNo

Authorized OfficialLaura RiceAuthorized Official · (843) 796-1769

Enumeration DateSeptember 17, 2025

NPPES CertifiedSeptember 17, 2025

✔ NPI 1134090582 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreventive Medicine · Public Health & General Preventive MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2083P0901X

Definition

Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings.

4006 POSTAL WAY UNIT A, Myrtle Beach, SC 29579

Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Coastal Med Spa, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Coastal Med Spa, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Bi Tadzong-Fomundam, M.D.

Preventive Medicine

NPI 1710148648

4006 POSTAL WAY UNIT A
Myrtle Beach, SC 29579

(843) 796-1769

✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Coastal Med Spa, LLC's NPI number?

The NPI number for Coastal Med Spa, LLC is 1134090582. It was assigned to this organization in the NPPES registry on September 17, 2025.

Where is Coastal Med Spa, LLC located?

Coastal Med Spa, LLC is located at 4006 Postal Way Unit A, Myrtle Beach, SC 29579. The listed phone number is (843) 796-1769.

What is Coastal Med Spa, LLC's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Public Health & General Preventive Medicine, with taxonomy code 2083P0901X.

Is Coastal Med Spa, LLC enrolled in Medicare?

Yes. Coastal Med Spa, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Coastal Med Spa, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Preventive Medicine) reassigns their Medicare billing to Coastal Med Spa, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Coastal Med Spa, LLC was last updated on September 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.