Provider Demographics
NPI:1508836974
Name:EASLEY M R I L L C
Entity Type:Organization
Organization Name:EASLEY M R I L L C
Other - Org Name:EASLEY MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:M D
Authorized Official - Phone:864-295-4410
Mailing Address - Street 1:PO BOX 3088
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29602-3088
Mailing Address - Country:US
Mailing Address - Phone:864-552-7470
Mailing Address - Fax:864-552-7471
Practice Address - Street 1:200 FLEETWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2022
Practice Address - Country:US
Practice Address - Phone:864-552-7470
Practice Address - Fax:864-552-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSL0051Medicaid
SCCJ7945OtherRAILROAD MEDICARE
SC7210Medicare PIN