=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952494304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH STRAND MEDICAL ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2006
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1945 GLENNS BAY ROAD
-----------------------------------------------------
City | SURFSIDE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-650-4006
-----------------------------------------------------
Fax | 843-650-1418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14690
-----------------------------------------------------
City | SURFSIDE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-650-4006
-----------------------------------------------------
Fax | 843-650-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | BRIAN K ADLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 843-650-4006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | 11949
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------