Provider Demographics
NPI:1144209628
Name:SOUTH STRAND CARDIOLOGY LLC
Entity Type:Organization
Organization Name:SOUTH STRAND CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-293-2700
Mailing Address - Street 1:207 CHARTWELL CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-9999
Mailing Address - Country:US
Mailing Address - Phone:843-293-2700
Mailing Address - Fax:843-293-4960
Practice Address - Street 1:207 CHARTWELL CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-9999
Practice Address - Country:US
Practice Address - Phone:843-293-2700
Practice Address - Fax:843-293-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3828Medicaid
SC7829Medicare PIN
SCGP3828Medicaid