Organization
LAKE CITY - KINGSTREE RADIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERT L BOOKER MD (PRESIDENT)
(843) 374-6171
Entity
Organization
Contact information
Practice address
258 N RON MCNAIR BLVD, LAKE CITY, SC 29560-2462
(843) 374-6171
(843) 374-6133
Mailing address
3328 GUESS RD, SUITE 2A, DURHAM, NC 27705-2158
(919) 620-5700
(919) 620-3632
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A4139
RAIL ROAD MEDICARE
SC
05
—
GP3037
—
SC
Enumeration date
01/08/2007
Last updated
10/23/2007
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