ANGELIC PRIMARY MEDICINE OF SC, LLC
NPI 1730752015
Nurse Practitioner - Primary Care in Myrtle Beach, SC

Q: What is Angelic Primary Medicine Of Sc, LLC's NPI number?

The NPI number for Angelic Primary Medicine Of Sc, LLC is 1730752015. It was assigned to this organization in the NPPES registry on July 23, 2021.

Q: What is Angelic Primary Medicine Of Sc, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Active since July 23, 2021CLIA 31D2195398 · Waiver

4728 JENN DR STE 102, MYRTLE BEACH, SC 29577(609) 464-1135(609) 822-7980 Get Directions Write a Review

NPPES record last updated: June 26, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 26, 2025, Oct 13, 2021, Jul 23, 2021 (3 updates tracked since 2021).

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About Angelic Primary Medicine Of Sc, Llc NPPES

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

ANGELIC PRIMARY MEDICINE OF SC, LLC (NPI 1730752015) is a healthcare organization registered as a primary care in Myrtle Beach, South Carolina and active in the NPI registry since July 2021. The organization holds a CLIA Waiver certificate valid through October 7, 2026 and lists Janet Gibson, Owner, as its authorized official.

NPPES Registry Identity

NPI1730752015

Entity TypeOrganization

Primary Taxonomy363LP2300X

Legal Business NameANGELIC PRIMARY MEDICINE OF SC, LLC

Location Address4728 JENN DR STE 102Myrtle Beach, SC 29577-5714

Mailing Address8025 Black Horse Pike Ste 501Pleasantville, NJ 08232-2967 · (609) 822-7979 · Fax (609) 822-7980

Phone(609) 464-1135

Fax(609) 822-7980

Organization SubpartNo

Authorized OfficialJanet GibsonOwner · (609) 464-1135

Enumeration DateJuly 23, 2021

Last NPPES UpdateJune 26, 20253 updates tracked since enumeration

NPPES CertifiedJune 26, 2025

✔ NPI 1730752015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

4728 JENN DR STE 102, Myrtle Beach, SC 29577

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Other Identifiers 1

Other24726SC · License

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include First Choice Next, Molina Healthcare.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2195398

Angelic Primary Medicine LLC · Wenonah, NJ

Active · expires Oct 7, 2026

CLIA Number31D2195398

Laboratory TypePractitioner Other

Certificate Effective DateOctober 8, 2024

Certificate Expiration DateOctober 7, 2026

Laboratory DirectorMelissa Mordesai

Laboratory Phone(609) 822-7979

Laboratory LocationAngelic Primary Medicine LLC1050 Mantua Pike, First Floor, Wenonah, NJ 08090

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLARITY HOSPICE OF SC LLC

Hospice Care, Community Based

4728 JENN DR STE 102
MYRTLE BEACH, SC 29577

Horry County (609) 515-4759

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 Angelic Primary Medicine Of Sc, LLC's NPI number?

The NPI number for Angelic Primary Medicine Of Sc, LLC is 1730752015. It was assigned to this organization in the NPPES registry on July 23, 2021.

Where is Angelic Primary Medicine Of Sc, LLC located?

Angelic Primary Medicine Of Sc, LLC is located at 4728 Jenn Dr Ste 102, Myrtle Beach, SC 29577. The listed phone number is (609) 464-1135.

What is Angelic Primary Medicine Of Sc, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Does Angelic Primary Medicine Of Sc, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D2195398) is associated with this NPI, valid through October 7, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Angelic Primary Medicine Of Sc, LLC accept?

Health plans from First Choice Next and Molina Healthcare list Angelic Primary Medicine Of Sc, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Angelic Primary Medicine Of Sc, LLC was last updated on June 26, 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.