Provider Demographics
NPI:1558354431
Name:BSR19,INC.
Entity Type:Organization
Organization Name:BSR19,INC.
Other - Org Name:BEDSIDE RADIOGRAPHICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-243-5420
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NC
Mailing Address - Zip Code:28760-0536
Mailing Address - Country:US
Mailing Address - Phone:828-243-5420
Mailing Address - Fax:828-667-1966
Practice Address - Street 1:1589 BROOKSIDE CAMP RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-8557
Practice Address - Country:US
Practice Address - Phone:828-243-5420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419807Medicaid
012TKOtherBLUE CROSSBLUE SHIELD NC
NC2530303Medicare ID - Type Unspecified