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	5599938	OTHER	NY	GHI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
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	:	1033178934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRAND REGIONAL SPECIALTY

Provider Business Mailing Address
First Line	:	PO BOX 70399
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-0025
Country	:	US
Telephone Number	:	843-449-2336
Fax Number	:	843-497-2505

Provider Business Practice Location Address
First Line	:	8170 ROURK ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4127
Country	:	US
Telephone Number	:	843-449-2336
Fax Number	:	843-497-2505

Authorized Official
Title or Position	:	INSURANCE SPECIALIST
Name	:	MRS. SONJA WILLIS
Credential	:
Telephone Number	:	843-692-2149

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/21/2010

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Directions to “STRAND REGIONAL SPECIALTY ” Practice Location

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