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NPI Code Detail

MEDICARE: KEOWEE RADIOLOGY P A

MEDICARE: KEOWEE RADIOLOGY P A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CH9258OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821097825
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEOWEE RADIOLOGY P A
Provider Business Mailing Address
First Line : PO BOX 49009
Second Line :
City : GREENWOOD
State : SC
Zip : 29649-0001
Country : US
Telephone Number : 864-223-3070
Fax Number :
Provider Business Practice Location Address
First Line : 298 MEMORIAL DR
Second Line :
City : SENECA
State : SC
Zip : 29672-9443
Country : US
Telephone Number : 864-885-7113
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BLAKE C POLEYNARD
Credential : MD
Telephone Number : 864-885-7113
Provider Enumeration Date : 07/20/2005
Last Update Date : 08/25/2010

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Practice Location Address:
298 MEMORIAL DR
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29672-9443
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1720079544 — WENDY SUE MANZON MD
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1801879473 — AARON JAY BOHN M.D.
Practice Location Address:
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1487637989 — THOMAS PAUL MARCOTTE CRNA
Practice Location Address:
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Practice Fax: 864-885-7619
1881677367 — FREDRICK MICHAEL AMATRIAIN CRNA
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298 MEMORIAL DR
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1760465249 — CYNTHIA L BRUCE CRNA
Practice Location Address:
298 MEMORIAL DR
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Directions to “KEOWEE RADIOLOGY P A ” Practice Location

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