Provider Demographics
NPI:1952494304
Name:SOUTH STRAND MEDICAL ARTS
Entity Type:Organization
Organization Name:SOUTH STRAND MEDICAL ARTS
Other - Org Name:SOUTH STRAND INTERNISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-650-4006
Mailing Address - Street 1:PO BOX 14690
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587
Mailing Address - Country:US
Mailing Address - Phone:843-650-4006
Mailing Address - Fax:843-650-1418
Practice Address - Street 1:1945 GLENNS BAY ROAD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-650-4006
Practice Address - Fax:843-650-1418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH STRAND MEDICAL ARTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11949332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
4226278OtherOTHER ID NUMBER-COMMERCIAL NUMBER
SCGP0439Medicaid
4226278OtherOTHER ID NUMBER-COMMERCIAL NUMBER