Provider Demographics
NPI:1295085231
Name:BLUEWATER IMAGING, LLC
Entity type:Organization
Organization Name:BLUEWATER IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-640-1185
Mailing Address - Street 1:1101 TROLLEY RD
Mailing Address - Street 2:200
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5293
Mailing Address - Country:US
Mailing Address - Phone:843-407-0551
Mailing Address - Fax:888-434-2583
Practice Address - Street 1:1101 TROLLEY RD
Practice Address - Street 2:200
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5293
Practice Address - Country:US
Practice Address - Phone:843-407-0551
Practice Address - Fax:888-434-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty