Healthcare Provider Details

I. General information

NPI: 1396703914
Provider Name (Legal Business Name): NORTH STRAND ULTRA SOUND VASCULAR & VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MAIN STREET
N MYRTLE BEACH SC
29582
US

IV. Provider business mailing address

PO BOX 407
N MYRTLE BEACH SC
29582
US

V. Phone/Fax

Practice location:
  • Phone: 843-249-1101
  • Fax: 843-249-1198
Mailing address:
  • Phone: 843-249-1101
  • Fax: 843-249-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE J DURHAM
Title or Position: ADMINISTRATOR
Credential: ARRT
Phone: 843-249-1101