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General NPI Number Information
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NPI Number | 1881617843
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Entity Type | Organization
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Legal Business Name | BEAUFORT MEDICAL IMAGING INC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 955 RIBAUT RD
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City | BEAUFORT
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State | SC
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Zip | 29902-5441
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Country | US
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Telephone | 843-522-5130
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Fax | 843-522-5538
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Provider Business Mailing Address
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Address Line | 5700 SOUTHWYCK BLVD
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City | TOLEDO
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State | OH
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Zip | 43614-1509
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Country | US
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Telephone | 800-288-8325
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Fax | 419-866-5453
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | CLYDE P. BLALOCK
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Credential |
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Telephone | 843-522-5200
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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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