Healthcare Provider Details

I. General information

NPI: 1912215427
Provider Name (Legal Business Name): SOUTHSIDE IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SOCIETY HILL DRIVE
AIKEN SC
29803
US

IV. Provider business mailing address

302 UNIVERSITY PKWY
AIKEN SC
29801-6302
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-5051
  • Fax:
Mailing address:
  • Phone: 803-641-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. CARLOS MILANES
Title or Position: CEO
Credential:
Phone: 803-641-5600