Provider Demographics
NPI:1528031192
Name:STRAND PHYSICIAN SPECIALISTS
Entity Type:Organization
Organization Name:STRAND PHYSICIAN SPECIALISTS
Other - Org Name:CAROLINA HEALTH SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-497-5929
Mailing Address - Street 1:4615 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5741
Mailing Address - Country:US
Mailing Address - Phone:843-497-5929
Mailing Address - Fax:843-497-9940
Practice Address - Street 1:1021 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4618
Practice Address - Country:US
Practice Address - Phone:843-449-7885
Practice Address - Fax:843-497-9940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRAND PHYSICIAN SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7878Medicare ID - Type Unspecified