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General NPI Number Information
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NPI Number | 1255685988
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Entity Type | Organization
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Legal Business Name | RAISED RADIOLAND PRODUCTIONS LLC
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 58 N BASILICA AVE
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City | HANAHAN
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State | SC
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Zip | 29410-8657
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Country | US
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Telephone | 206-295-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 58 N BASILICA AVE
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City | HANAHAN
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State | SC
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Zip | 29410-8657
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Country | US
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Telephone | 206-295-3621
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCEY TREVANIAN TSAI
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Credential | M.D.
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Telephone | 206-295-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 23922
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License Number State | SC
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