Provider Demographics
NPI:1841493640
Name:LOW COUNTRY RADIOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:LOW COUNTRY RADIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BERRIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-689-4155
Mailing Address - Street 1:PO DRAWER 7586
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29938-7586
Mailing Address - Country:US
Mailing Address - Phone:843-689-4155
Mailing Address - Fax:843-689-4155
Practice Address - Street 1:460 WILLIAM HILTON PARKWAY
Practice Address - Street 2:SUITE E
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2498
Practice Address - Country:US
Practice Address - Phone:843-689-4155
Practice Address - Fax:843-689-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC75472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4236Medicaid
SCGP4236Medicaid