1386696524 NPI number — MRI INTERPRETATIONS PC

Table of content: DR. THOMAS JOHN WILLKE M.D. (NPI 1184617888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386696524 NPI number — MRI INTERPRETATIONS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRI INTERPRETATIONS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386696524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUFFTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29910-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-815-6411
Provider Business Mailing Address Fax Number:
843-815-6416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 HOSPITAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILTON HEAD ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29926-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-681-6122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
REX
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
843-815-6411

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP0372 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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