Healthcare Provider Details

I. General information

NPI: 1801206669
Provider Name (Legal Business Name): E-RADIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 WOODLAND AVE
MT PLEASANT SC
29464-3288
US

IV. Provider business mailing address

1241 WOODLAND AVE
MT PLEASANT SC
29464-3288
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-4020
  • Fax: 843-824-0909
Mailing address:
  • Phone: 843-881-4020
  • Fax: 843-824-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateSC

VIII. Authorized Official

Name: MS. VICKI RICHTER
Title or Position: FACILITY MANAGER
Credential:
Phone: 843-881-4020