=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518942960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILTON HEAD IMAGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2005
-----------------------------------------------------
Last Update Date | 09/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 MAIN STREET SUITE 103
-----------------------------------------------------
City | HILTON HEAD ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-342-5767
-----------------------------------------------------
Fax | 843-342-5898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 MAIN STREET SUITE 103
-----------------------------------------------------
City | HILTON HEAD ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-342-5767
-----------------------------------------------------
Fax | 843-342-5898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASST
-----------------------------------------------------
Name | MS. LINDA L THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-342-5767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------