MEDICARE: STRAND REGIONAL SPECIALTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5599938	OTHER	NY	GHI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366469397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRAND REGIONAL SPECIALTY

Provider Business Mailing Address
First Line	:	PO BOX 100523
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-0523
Country	:	US
Telephone Number	:	843-669-5162
Fax Number	:	843-667-4573

Provider Business Practice Location Address
First Line	:	3617 CASEY ST
Second Line	:	SUITE D
City	:	LORIS
State	:	SC
Zip	:	29569-2981
Country	:	US
Telephone Number	:	834-756-9729
Fax Number	:	843-390-0038

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIM SMITH
Credential	:
Telephone Number	:	843-692-2167

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	04/20/2008

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1275534307 — DOLI ELIZABETH BIONDILLO MD
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1619933868 — NORTH STRAND OB/GYN, P.C.
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1679665608 — CHRISTOPHER L PO MD
Practice Location Address:

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Directions to “STRAND REGIONAL SPECIALTY ” Practice Location

Language	Start Address	Practice Location

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