Provider Demographics
NPI:1366469397
Name:STRAND REGIONAL SPECIALTY
Entity Type:Organization
Organization Name:STRAND REGIONAL SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-692-2167
Mailing Address - Street 1:PO BOX 100523
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0523
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:3617 CASEY ST
Practice Address - Street 2:SUITE D
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2981
Practice Address - Country:US
Practice Address - Phone:834-756-9729
Practice Address - Fax:843-390-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1819815Medicaid
NY5599938OtherGHI
SCGP3642Medicaid
NC790167KMedicaid
NC790167KMedicaid
SCGP3642Medicaid