1841493640 NPI number — LOW COUNTRY RADIOLOGY ASSOCIATES LLC

Table of content: (NPI 1841493640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841493640 NPI number — LOW COUNTRY RADIOLOGY ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOW COUNTRY RADIOLOGY ASSOCIATES LLC
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:
1841493640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER 7586
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILTON HEAD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29938-7586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-689-4155
Provider Business Mailing Address Fax Number:
843-689-4155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 WILLIAM HILTON PARKWAY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HILTON HEAD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29926-2498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-689-4155
Provider Business Practice Location Address Fax Number:
843-689-4155
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERRIGAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
CONTRACT PHYSICIAN
Authorized Official Telephone Number:
843-689-4155

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  7547 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP4236 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com