Healthcare Provider Details

I. General information

NPI: 1952724775
Provider Name (Legal Business Name): RADIOLOGY PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CLARK SUMMIT DR
BLUFFTON SC
29910-4963
US

IV. Provider business mailing address

18 CLARK SUMMIT DR
BLUFFTON SC
29910-4963
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-9700
  • Fax: 843-815-9701
Mailing address:
  • Phone: 843-815-9700
  • Fax: 843-815-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: A JOSEPH BORELLI JR.
Title or Position: PRESIDENT & MEDICAL DIRECTOR
Credential: MD
Phone: 843-815-9700