Healthcare Provider Details

I. General information

NPI: 1053399378
Provider Name (Legal Business Name): MRI AT BELFAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/30/2022
Certification Date: 01/30/2022
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 Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number20797
License Number StateSC

VIII. Authorized Official

Name: DR. ALBERT JOSEPH BORELLI JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-815-9700