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General NPI Number Information
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NPI Number | 1417423088
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Entity Type | Organization
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Legal Business Name | BON SECOURS DIAGNOSTIC IMAGING
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 1 MARCUS DR STE 100
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City | GREENVILLE
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State | SC
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Zip | 29615-4818
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Country | US
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Telephone | 864-751-2051
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Fax | 864-751-2050
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Provider Business Mailing Address
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Address Line | 3480 PRESTON RIDGE RD STE 600
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City | ALPHARETTA
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State | GA
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Zip | 30005-5462
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Country | US
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Telephone | 678-992-7255
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Fax | 678-992-7455
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Authorized Official
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Title or Position | VP REIMBURSMENT
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Name | KIMBERLY M RALSTON
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Credential |
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Telephone | 419-996-5119
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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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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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