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Organization
MAN IN THE BOX ANESTHESIA LLC
Active
Organization
MAN IN THE BOX ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK HORSTEMEYER MD (PRESIDENT)
(240) 566-1600
Entity
Organization
Contact information
Practice address
809 82ND PKWY, ANESTHESIA DEPT, MYRTLE BEACH, SC 29572-4607
(240) 566-1600
Mailing address
PO BOX 932802, ATLANTA, GA 31193-2802
(240) 566-1600
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3781
—
SC
Enumeration date
01/19/2006
Last updated
07/21/2022
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