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General NPI Number Information
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NPI Number | 1205149051
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Entity Type | Organization
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Legal Business Name | TELERAD OF SC ACCOUNT MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 37 OFF SHR
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City | HILTON HEAD
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State | SC
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Zip | 29928-5273
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Country | US
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Telephone | 973-251-1132
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD SUITE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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