# MAN IN THE BOX ANESTHESIA LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760462378
- **Authorized official:** DR. DEREK HORSTEMEYER MD (PRESIDENT)
- **Authorized official phone:** (240) 566-1600

## Contact information

- **Practice address:** 809 82ND PKWY, ANESTHESIA DEPT, MYRTLE BEACH, SC 29572-4607
- **Practice address phone:** (240) 566-1600
- **Mailing address:** PO BOX 932802, ATLANTA, GA 31193-2802
- **Mailing address phone:** (240) 566-1600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | SC | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | SC | — |

## Other

- **Enumeration date:** 01/19/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP3781 | — | SC |