Provider Demographics
NPI:1134146160
Name:STRAND REGIONAL SPECIALTY
Entity Type:Organization
Organization Name:STRAND REGIONAL SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-692-2149
Mailing Address - Street 1:PO BOX 70399
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0025
Mailing Address - Country:US
Mailing Address - Phone:843-692-2149
Mailing Address - Fax:843-497-2505
Practice Address - Street 1:2376 CYPRESS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8964
Practice Address - Country:US
Practice Address - Phone:843-234-1710
Practice Address - Fax:843-234-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2761Medicaid
NY5599938OtherGHI
PA1819815Medicaid
NC790167KMedicaid
NY5599938OtherGHI
NC790167KMedicaid