MEDICARE: BEAUFORT OPEN MRI, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	14702	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053375642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	1319 LADYS ISLAND DR
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1153
Country	:	US
Telephone Number	:	843-524-6736
Fax Number	:	843-524-1386

Provider Business Practice Location Address
First Line	:	1319 LADYS ISLAND DR
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1153
Country	:	US
Telephone Number	:	843-524-6736
Fax Number	:	843-524-1386

Authorized Official
Title or Position	:	NEUROLOGIST
Name	:	PAUL MAZZEO
Credential	:	M.D.
Telephone Number	:	843-522-1420

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	02/06/2012

Similar Medicare Providers

1295607802 — ANGEL JAMES MARTENS
Practice Location Address:

1153 N 5TH ST
PORT HUENEME, CA
93041-2503

Practice Phone: 805-407-2466
Practice Fax:

1326765991 — UNKNOWN NKENGAFAC FUALEFAC FONGE
Practice Location Address:

9932 PRINCE ROYAL PL
UPPER MARLBORO, MD
20774-1153

Practice Phone: 484-542-2588
Practice Fax:

1598620411 — THE BRIDGE 14-6 LLC
Practice Location Address:

9932 PRINCE ROYAL PL
UPPER MARLBORO, MD
20774-1153

Practice Phone: 484-686-2032
Practice Fax:

1386613172 — DR. GREGORY P LONSCAK DC, DNP, FNP-C
Practice Location Address:

1718 RIBAUT RD
PORT ROYAL, SC
29935-1927

Practice Phone: 843-986-0900
Practice Fax:

1669892626 — MRS. ALEXANDRA L EDENFIELD PA
Practice Location Address:

2210 MOSSY OAKS RD
PORT ROYAL, SC
29935-1046

Practice Phone: 843-986-0900
Practice Fax:

1861586414 — JOHN BRUCE ETHERIDGE MD
Practice Location Address:

1320 RIBAUT RD
PORT ROYAL, SC
29935-1118

Practice Phone: 843-986-0900
Practice Fax:

Directions to “BEAUFORT OPEN MRI, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.