Provider Demographics
NPI:1144420027
Name:PAVILLION IMAGING CENTER LLC
Entity Type:Organization
Organization Name:PAVILLION IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-681-8203
Mailing Address - Street 1:25 HOSPITAL CENTER BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926
Mailing Address - Country:US
Mailing Address - Phone:843-681-8203
Mailing Address - Fax:843-689-6283
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926
Practice Address - Country:US
Practice Address - Phone:843-681-8203
Practice Address - Fax:843-689-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty