Healthcare Provider Details

I. General information

NPI: 1366469397
Provider Name (Legal Business Name): STRAND REGIONAL SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 CASEY ST SUITE D
LORIS SC
29569-2981
US

IV. Provider business mailing address

PO BOX 100523
FLORENCE SC
29501-0523
US

V. Phone/Fax

Practice location:
  • Phone: 834-756-9729
  • Fax: 843-390-0038
Mailing address:
  • Phone: 843-669-5162
  • Fax: 843-667-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIM SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-692-2167