Healthcare Provider Details

I. General information

NPI: 1053353508
Provider Name (Legal Business Name): SOUTHEASTERN IMAGING CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DURALEIGH RD SUITE 101
RALEIGH NC
27612-8104
US

IV. Provider business mailing address

PO BOX 16573
CHAPEL HILL NC
27516-6573
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-9091
  • Fax: 919-785-9776
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND F EVELAND
Title or Position: MEMBER
Credential:
Phone: 336-202-5593