Provider Demographics
NPI:1497700496
Name:SOUTHERN MRI LLC
Entity Type:Organization
Organization Name:SOUTHERN MRI LLC
Other - Org Name:MEDICAL BILLING OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-815-4600
Mailing Address - Street 1:PO BOX 8007
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29938-8007
Mailing Address - Country:US
Mailing Address - Phone:843-815-4600
Mailing Address - Fax:
Practice Address - Street 1:49 PENNINGTON DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6036
Practice Address - Country:US
Practice Address - Phone:843-815-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSL0024Medicaid
SC5855Medicare PIN