MEDICARE: STRAND PHYSICIAN SPECIALISTS

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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1528031192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRAND PHYSICIAN SPECIALISTS

Provider Business Mailing Address
First Line	:	4615 OLEANDER DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5741
Country	:	US
Telephone Number	:	843-497-5929
Fax Number	:	843-497-9940

Provider Business Practice Location Address
First Line	:	1021 MEDICAL CIR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4618
Country	:	US
Telephone Number	:	843-449-7885
Fax Number	:	843-497-9940

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	KENNETH L DEHART
Credential	:	MD
Telephone Number	:	843-497-5929

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/20/2007

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