Organization
SOUTHEAST REGIONAL VIRTUAL IMAGING CONSULTING ENTERPRISE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN JACOB GORDIN M.D. (PRESIDENT)
(864) 468-5238
Entity
Organization
Contact information
Practice address
225 STABLE GATE DR, CAMPOBELLO, SC 29322-8037
(864) 468-5570
(864) 468-5239
Mailing address
PO BOX 52990, GREENWOOD, SC 29649-0048
(864) 223-3600
(864) 223-6054
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
16566
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4506
—
SC
Enumeration date
08/03/2006
Last updated
12/21/2007
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