1649468810 NPI number — STRAND ORTHOPAEDIC CONSULTANTS, LLC

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 1649468810 NPI number — STRAND ORTHOPAEDIC CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRAND ORTHOPAEDIC CONSULTANTS, LLC
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:
Provider Other Organization Name Type Code:
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:
1649468810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 82ND PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29572-4614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-449-9457
Provider Business Mailing Address Fax Number:
843-449-7957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4237 RIVER HILLS DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE RIVER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29566-6444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-280-7505
Provider Business Practice Location Address Fax Number:
843-280-8785
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
843-449-9457

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP1952 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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