Provider Demographics
NPI:1073546875
Name:STRAND GASTROINTESTINAL ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:STRAND GASTROINTESTINAL ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-492-2751
Mailing Address - Street 1:7900 N KINGS HWY STE B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-3055
Mailing Address - Country:US
Mailing Address - Phone:843-839-2581
Mailing Address - Fax:843-839-2585
Practice Address - Street 1:7900 N KINGS HWY STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-3055
Practice Address - Country:US
Practice Address - Phone:843-839-2581
Practice Address - Fax:843-839-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF062261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC033Medicaid
D17659Medicare UPIN
A57142Medicare UPIN
SCASC033Medicaid
F89126Medicare UPIN