Provider Demographics
NPI:1851356331
Name:STRAND LUNG CENTER
Entity Type:Organization
Organization Name:STRAND LUNG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSE
Authorized Official - Phone:843-449-5864
Mailing Address - Street 1:P O BOX 7637
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0015
Mailing Address - Country:US
Mailing Address - Phone:843-449-5864
Mailing Address - Fax:843-692-3012
Practice Address - Street 1:SUITE C 1304 48TH AVE
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5427
Practice Address - Country:US
Practice Address - Phone:843-449-5864
Practice Address - Fax:843-692-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21961261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT61769Medicaid
SCT61769Medicaid