Healthcare Provider Details

I. General information

NPI: 1407801863
Provider Name (Legal Business Name): SOUTHERN MRI HILTON HEAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 WILLIAM HILTON PKWY SUITE F1
HILTON HEAD ISLAND SC
29926-2497
US

IV. Provider business mailing address

PO BOX 190
BLUFFTON SC
29910-0190
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-5636
  • Fax:
Mailing address:
  • Phone: 843-815-6411
  • Fax: 843-815-6416

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: CHRIS JENKINS
Title or Position: MANAGER
Credential:
Phone: 843-681-5636