Basic Information
| Provider Information | |||||||||
| NPI: | 1720075435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 AZALEA CT | ||||||||
| Address2: | STE C | ||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436920570 | ||||||||
| FaxNumber: | 8434979566 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 E CHEVES ST | ||||||||
| Address2: | RADIOLOGY DEPT | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436695162 | ||||||||
| FaxNumber: | 8436674573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 16723 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 16723 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 570525838 | 01 | SC | STANDARD TAX ID | OTHER | 154758900 | 01 | SC | US DEPT OF LABOR | OTHER | 167232 | 05 | SC | MEDICAID | 890539L | 01 | NC | NC MEDICAID | OTHER | 300070776 | 01 | SC | RR MEDICARE | OTHER | 0539L | 01 | NC | BCBS OF NC | OTHER | 154758900 | 01 | SC | FEDERAL BLACK LUNG | OTHER | 73987 | 01 | SC | MEDCOST | OTHER |