Healthcare Provider Details

I. General information

NPI: 1033178934
Provider Name (Legal Business Name): STRAND REGIONAL SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 ROURK ST
MYRTLE BEACH SC
29572-4127
US

IV. Provider business mailing address

PO BOX 70399
MYRTLE BEACH SC
29572-0025
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-2336
  • Fax: 843-497-2505
Mailing address:
  • Phone: 843-449-2336
  • Fax: 843-497-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SONJA WILLIS
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 843-692-2149