Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grand Strand Pediatrics & Adolescent Medicine, PA

Organization Pediatric Adolescent Medicine Physician · NPI 1588614192

Grand Strand Pediatrics & Adolescent Medicine, PA is a Pediatric Adolescent Medicine Physician in Myrtle Beach, South Carolina. Licensed in South Carolina. Registered with an NPI since 2006.

Licensed in
SC
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

8120 Rourk St
Myrtle Beach, SC 29572-4127
Phone: (843) 449-1438
Fax: (843) 286-1349
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Adolescent Medicine Physician (primary) Taxonomy 2080A0000X · Licence 7085 (SC)

Record details

NPI number1588614192
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Thomas Petrusick — Owner/Physician · (843) 449-1438
NPI enumeratedMay 12, 2006
Last updated in NPPESFebruary 25, 2014
Mailing address8120 Rourk St, Myrtle Beach, SC 29572-4127

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