Organization
RICHLAND RADIOLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ENRIQUE V BOUFFARD III MD (PRESIDENT)
(618) 262-7303
Entity
Organization
Contact information
Practice address
326 W 3RD STREET, MOUNT CARMEL, IL 62863
(618) 262-7303
(618) 262-2304
Mailing address
PO BOX 68, MT CARMEL, IL 62863
(618) 262-7303
(618) 262-2304
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036054461
—
IL
Enumeration date
08/29/2006
Last updated
07/22/2010
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