1851356331 NPI number — STRAND LUNG CENTER

Table of content: (NPI 1851356331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851356331 NPI number — STRAND LUNG CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRAND LUNG CENTER
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:
1851356331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 7637
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:
29572-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-449-5864
Provider Business Mailing Address Fax Number:
843-692-3012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE C 1304 48TH AVE
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:
29577-5427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-449-5864
Provider Business Practice Location Address Fax Number:
843-692-3012
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEIBMAN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
843-449-5864

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  21961 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T61769 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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