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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