Healthcare Provider Details

I. General information

NPI: 1861671711
Provider Name (Legal Business Name): SOUTHERN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PENNINGTON DR STE B
BLUFFTON SC
29910-9014
US

IV. Provider business mailing address

40 PALMETTO PKWY
HILTON HEAD SC
29926-3759
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-4600
  • Fax: 843-815-4601
Mailing address:
  • Phone: 843-681-5636
  • Fax: 843-681-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRIS JENKINS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 843-815-4600