Provider Demographics
NPI:1396703914
Name:NORTH STRAND ULTRA SOUND VASCULAR & VEIN CENTER
Entity type:Organization
Organization Name:NORTH STRAND ULTRA SOUND VASCULAR & VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:843-249-1101
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:N MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582
Mailing Address - Country:US
Mailing Address - Phone:843-249-1101
Mailing Address - Fax:843-249-1198
Practice Address - Street 1:710 MAIN STREET
Practice Address - Street 2:
Practice Address - City:N MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582
Practice Address - Country:US
Practice Address - Phone:843-249-1101
Practice Address - Fax:843-249-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSL0073Medicaid
NC8105019Medicaid
NC8977458Medicaid