Basic Information
| Provider Information | |||||||||
| NPI: | 1366469397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRAND REGIONAL SPECIALTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100523 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295010523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436695162 | ||||||||
| FaxNumber: | 8436674573 | ||||||||
| Practice Location | |||||||||
| Address1: | 3617 CASEY ST | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8347569729 | ||||||||
| FaxNumber: | 8433900038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8436922167 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 1819815 | 05 | PA | MEDICAID | 5599938 | 01 | NY | GHI | OTHER | GP3642 | 05 | SC | MEDICAID | 790167K | 05 | NC | MEDICAID |