1972736528 NPI number — STRAND PHYSICIAN SPECIALISTS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972736528 NPI number — STRAND PHYSICIAN SPECIALISTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRAND PHYSICIAN SPECIALISTS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAROLINA HEALTH SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972736528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3439
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29582-0439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-839-4447
Provider Business Mailing Address Fax Number:
843-399-0123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4591 SOCASTEE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29588-7209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-497-5929
Provider Business Practice Location Address Fax Number:
843-839-4477
Provider Enumeration Date:
08/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VEREEN
Authorized Official First Name:
KARI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
843-497-5929

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L00277 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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